f U.S. economy, but his faith in "trickle-down" distribution theories leaves millions out of the money. Internal reforms initiated by Soviet-leader Mikhail Gorbachev in the mid-8os trigger a
cascade of events that will lead to the fall of the Berlin wall in 1 9 8 9
and the gradual breakup of the Soviet Union. The new global
political order that evolves will be marked by both grisly humanitarian crises and the spread of democratic freedoms to Eastern
Europe, southern Africa, and part of Asia and South America
Actor Rock Hudson's death from

AIDS

in 1 9 8 5 , combined

with Surgeon General C. Everett Koop's outspoken criticism of
government inaction, finally galvanizes a national response to
the epidemic, but not in time to stay its course. By the end of 1 9 9 7 ,
AIDS

has claimed more than 2. million lives worldwide, and 3 1 mil-

lion people carry the Hiv virus. Heart disease remains America's
leading killer, but its long decline, coupled with steadily rising cancer
mortality, set the stage for a changing of the guard.
At the School of Public Health, 3 8-year-old health policy
professor Harvey V. Fineberg succeeds Howard Hiatt as dean.
Fineberg will lead the School through an era of prosperity
and growth that coincides with a groundswell of support for
public health's fundamental principle prevention.

the
gathering
storm
Harvard scientists confront a threat of

by Sarah

/4brams

bib!ica! dimensions that cha!!enges and transforms
the fundamenta! tenets of pubtic heaith.
1985

Cardiologist Bernard Lown and Russian colleague
Eugene Chazov accept the Nobel Peace Prize on
behalf of the International Physicians for the
Prevention of Nuclear War, which the pair co-founded
in 1980.

] ical student doing his hrst clinical
H rotations at University of N e w
Mexico Hospital, Richard Marlink
was shown a patient with an
extremely rare form of cancer. The
attending resident explained that this
malignancy, known as Kaposi's sarcoma, typically was found only in
older men of Mediterranean descent
and was usually quite benign. He
ended his talk by telling Marlink and
his colleagues that this was probably
the only case of Kaposi's sarcoma
they would see in their careers. He
couldn't have been more wrong.
As an intern at St. Vincent's
Hospital in N e w Y o r k City in the
early 1 9 8 0 s , Marlink began seeing
other patients with the characteristic
bruise-like lesions of Kaposi's sarcoma. These cases, however, were different from the one he'd seen as a
medical student: the majority were
young adults most of whom had
other severe symptoms, including
Weight loss, swollen lymph nodes,
Pneumonia, and diarrhea. Few ever
recovered. Marlink, now executive
director of the Harvard AIDS
Institute, based at the Harvard
School of Pubhc Health, recalls the
frustration he and his colleagues felt
as they saw patient after patient for
whom none of the standard explanations applied. " W e knew there was a
syndrome," says Marlink today, "but
We didn't know what to do about it."
B y the time this m y s t e r i o u s n e w
syndrome had a permanent

Hunger in America: The Growing Epidemic", a
[sport of the HSPH-based Physician Task Force on
^ n g e r in America h e a d e d by J. Larry Brown, finds
at some 20 million Americans go hungry every
Honth.

the virus that caused it. Since then,
the AIDS epidemic has claimed at
least 6 million lives worldwide, and
an estimated 25 million people are
now living with the virus. Within a
decade, according to some estimates,
as many as 1 0 0 million people may
be infected. In certain areas of the
world and certain populations, the
epidemic has wreaked particular
havoc. Over 90 percent of the
world's AIDS cases occur in SubSaharan Africa, North America, and
Latin America. In the United States,
where the disease hrst devastated the
gay community, AIDS is now the leading cause of death for all African
Americans under the age of 55. In
Uganda, researchers estimate that
one-in-four adults is now infected
with the virus, perhaps foreshadowing a secondary epidemic of children
orphaned by the disease. And in
Thailand and India, skyrocketing
infection rates portend an Asian epidemic that may exceed in scale and
intensity anything seen to date.
Yet mortality and morbidity
figures, no matter how staggering,
can't fully describe the impact that
AIDS has had on the world. N o t since
the 1 9 1 8 influenza epidemic has an
infectious agent cut such a broad
swath of destruction around the planet. But whereas influenza struck hard
and fast and then passed on, A I D S has
infiltrated the social body, exposing
weaknesses and blindspots and challenging long-held beliefs about disease susceptibility and control. At the
same time, A I D S has to a large degree
revitalized the held of pubhc health,
exposing the limits of curative medicine and rejuvenating the search for
preventive vaccines and effective

Karen Quinlan, c o m a t o s e
since 1976, dies after being
removed from her respirator.

behavioral interventions and creating
a sense of urgency and global solidarity in the face of a mounting crisis.
Right from the start, faculty and
alumni of the Harvard School of
Public Health has played a key role in
confronting the epidemic. From laboratory discoveries that have set the
direction for AIDS vaccine and treatment research to important epidemiologic, data analysis, and human rights
work, the School has been a major
participant in the fight against A I D S .
H

N M A N Y R E S P E C T S , M A X E S S E X WAS

H an unlikely hero in the A I D S saga.
H A veterinarian and virologist by
training, Essex had spent most of his
career studying the animal virus FeLV,
which causes cancer in cats. In the
early 1 9 7 0 s , he had discovered that
this virus also severely impaired the
cats' immune system.
By 1 9 8 z, Essex, now chair of the
School's Department of Cancer
Biology, was also researching the
human T-cell leukemia virus ( H T L V 1). Like F e L V , H T L V - i caused immune
suppression—people infected with
H T L V - i had three times the rate of
infection with bacteria and other
viruses as uninfected people. Essex
was struck by the similarities between
symptoms of F e L V , H T L V - i , and this
new disease, and he was one of the
hrst to suggest that the mysterious
a g e n t c a u s i n g AIDS w a s , like FeLV a n d

a retrovirus. Essex's insight
accelerated the discovery of the AIDS
pathogen, now know as the human
immunodeficiency virus (Hiv), by the
National Cancer Institute's Robert
Gallo and the Pasteur Institute's Luc
Montagnier the following year. For
his role in identifying the cause of
HTLV-i,

British scientists
discoveraholeinthe
ozone layer.

screening. Working with a young
research associate Tun-Hou Lee,
s.D.'8z, now professor of virology at
the School, Essex discovered glycoprotein 12.0 (gpizo), an envelope
protein that plays a key role in HIV
transmission and is seen as a promising target for an HIV vaccine.

Mar/w^,

Dz'recfor o/ f^e

A I D S , Essex shared the 1 9 8 6 Albert
Lasker Medical Research A w a r d â&#x20AC;&#x201D;
the nation's most prestigious medical
research awardâ&#x20AC;&#x201D;with Gallo and
Montagnier.
" M a x catalyzed the notion that
retroviruses were something to contend with, that they were diseasecausing agents in animals, and that
they could play an important role in
humans," said Gallo in a 1 9 8 8 interview in the H S P H Alumni Bulletin.
" H e went beyond standard biological
thinking about animal models. He
looked at the importance of retroviruses broadly and widely."
Other important discoveries followed. In collaboration with scientific
colleagues, Essex confirmed that the
A I D S virus could be transmitted
through blood transfusions. Further
studies showed which viral antigens
were most useful for blood bank

In 1 9 8 5 , Associate Professor
Phyllis Kanki, s . D . ' 8 5 , Francis Barin,
then a postdoctoral fellow at H S P H ,
and Essex uncovered evidence of a
second A I D S virus, now known as
H i v - 2 . , when they found cross-reactive antibodies in West African sex
workers. With Marlink and other
French and Senegalese collaborators,
a major research and training program was created that continues
today. Their work has revealed that
Hiv-2. causes disease more slowly and
spreads less readily than the more virulent H i v - 1 , and that people with
Hiv-z are 70 percent less likely to
become infected with H i v - i .
"Once we understand how this
happens, we'll know how to manipulate the immune system just as evolution did," Essex says. Because of "the
utility of this discovery," Gallo
ranked Essex's work on H i v - z among
his major achievements.
Essex has said that the emergence
of A I D S created a sense of urgency in
his research that he still feels today.
"With A I D S , I think we all felt that
putting in the extra hours could make
a big difference," he told a Boston
Phoenix reporter last October. A I D S
also awakened him to the global
dimensions of infectious disease, and
he has spent much of the last decade
continent hopping from North
America to Africa to Asia in an effort
to finally outflank his adversary.

James 0 . Mason
M.P.H.'63, D.P.H/67,
succeeds William
Foege as head of the

rn

HH rn H I L E L A B O R A T O R Y SCIEN-

tists would be instrumen"
"
tal in identifying the
causative agent of A I D S , some of the
first clues about the nature of the
epidemic were provided by H S P H
graduates working on the front lines
of the epidemic. Don Francis, s . D / 7 9 ,
had recently graduated from the
School and was working in the
Centers for Disease Control's (CDC)
hepatitis program when the first
reports of gay-related immunodeficiency disease ( G R I D ) began trickling in. The CDC and state public
health officials had long been interested in the health problems of gay
men because rates of sexually transmitted diseases, primarily gonorrhea,
syphilis, and hepatitis B, among this
population were so high. T o find out
why, CDC enlisted cohorts of gay
men throughout the country to
answer detailed questionnaires a b o u t
their lives and sexual practices.
Because they received treatment free
of charge, says Francis, these men
were "remarkably willing to answer
a bunch of stupid questions from
epidemiologists."
The data collected proved invaluable in understanding the transmission patterns of this new disease.
Although no one knew what was
causing the disease, once it was e s t a b lished that G R I D , like hepatitis B,
was being transmitted through b l o o d
and sexual fluids, Francis felt sure it
would also begin showing up in o t h e f
vulnerable populations: recipients
of blood transfusions and injection
drug users. (Serum samples g a t h e r e d
from these cohorts in the 1 9 7 0 s a n d
early 1 9 8 0 s would also shed light
on H i v ' s long incubation period.)

Brazil returns to civilian
rule after 21 y e a r s of
military dictatorship.

It was Francis who called Essex, his
former teacher, to alert him to this
new disease.
As the epidemic took off, Francis's
boss, C D C Director William Foege,
M . p . H . ' g j , appointed James Curran,
M.p.H.'y^, then head of the agency's
venereal diseases research branch,
to head a national A I D S initiative.
Curran quickly moved forward on
establishing effective data collection
and prevention programs. He also
set up a national A I D S hotline to provide information to an increasingly
alarmed public. Despite these efforts,
Curran and other government
officials and academics soon came
under fire from A I D S activists for
responding too slowly to the epidemic. Francis, who eventually resigned
hom the C D C in frustration in 1 9 8 5
when Congress rejected his proposal
for a comprehensive A I D S prevention
Program, says the C D C was continually undercut by the Administration's
lack of commitment to fighting A I D S .
"We were told to look pretty and
do nothing," he says. "The (Reagan)
Administration didn't want to
do anything for anybody. It lost
all perspective for public health."
Curran has since been recognized
by AIDS activists and medical experts
alike for his clear, decisive leadership
during a period in which the
unknowns far outweighed the
ktiowns. In his 1988 chronicle of the
epidemic's early years,
BawJ
^ a y e j O?!, journalist Randy Shilts
Wrote: "Under Curran's leadership,
the CDC had done an admirable job of
collecting A I D S data. He had guided
^Dc AIDS research on a course that he
eh was the best that could be done
'n a conservative administration."

M<2% Essex, Mary
Pro/essor o/^Hea/f^
^cz'ewces
J

"Curran pushed the C D C and the
public health service hard to recognize
the impending epidemic," says the
Harvard A I D S Institute's Marlink.
"He organized much of our epidemiologic and prevention response."
Another alumnus who would play
a central role in the A I D S struggle on
the international front was Jonathan
Mann, M . p . H . ' 8 o . Mann was working
as an epidemiologist and assistant
director of the department of health
in New Mexico when Curran tapped
him to serve as assistant to the
director in charge of international
activities in Kinshasa, Zaire. Working
with Zairian, Belgian, and American
colleagues, Mann established Project
S I D A , providing training programs
that drew upon the resources and
skills of each country and collecting
the first and most comprehensive scientific information on A I D S in central
Africa. In 1 9 8 5 , Mann organized
the first African A I D S Conference in
the Central African Republic city of
Bangui. The following year he left the
C D C to develop and run the Global
Programme on A I D S ( G P A ) at the
World Health Organization ( W H O ) .

Actor Rock Hudson dies
ofAIDS. Since 1981
25,000 Americans have
been diagnosed with
the disease.

Under his leadership, the C P A ' s staff
expanded to over zoo and its budget
grew from $2.0 million to over $ 1 0 0
million by 1990, making the G P A
the largest single program at W H O .
During his years at both the C D C
and W H O , Mann emerged as a preeminent spokesman for international
health strategy reform in A I D S control, emphasizing the need for greater
government involvement in A I D S
research and prevention and
increased attention to regional and
local needs in establishing programs.
But above all, Mann spoke out
for the rights of those infected and
against the discrimination to which
they were subjected. To combat
the disease effectively, he believed,
human rights issues must become a
priority.
In the fall of 1990, Mann returned
to the Harvard School of Public
Health as professor of epidemiology
and head of the Global A I D S Policy
Coalition, established to track the
epidemic worldwide. Under the direction today of Daniel Tarantola, the
program is at the heart of monitoring
the pandemic, circulating information

CBAR Takes Center Stage
White preventive vaccines are still in the r&d stage, the search for
safe, effective AIDS drug treatments to keep the disease at bay has
produced some important results. The School's Statistical and Data
Analysis Center (SDAC), has been at the heart of this search since
1989, when it was designated to oversee most of the governmentsponsored aids drug trials. Since then, SDAC's group of 150
researchers have followed more then 300 different clinical trials
involving 37,500 people. Researchers are involved in each step of
the trials process—from the earliest planning stages to the final
data analysts.
Among the many important findings to emerge from these trials,
according to Center Director Stephen Lagakos, two in particular stand
out: ACTG 076, which showed that AZT reduced the chances of HIV
transmission from HIV-positive pregnant women to their babies, from
one-in-four to one-in-twelve; and ACTG 019, which showed that AZT
effectively slows disease progression in asymptomatic adults.
Of all the trials, says Lagakos, ACTG 076 will probably have the
the greatest potential for saving lives:" It provides a way to stop the
spread of the disease from mothers to their offspring, sparing millions of children from having miserable lives." Because doses are

t h r o u g h articles, AIDS t e x t b o o k s ,
interviews, a n d participation at
conferences.
Y 1987, T H E N U M B E R O F A I D S
cases reported to the World
t ^ Heath Organization was over
100,000. While experts recognized
A I D S as a global phenomenon, tracking the disease was complex, as the
pandemic evolved, changed, and
rapidly expanded. In countries where
infection had once been spread
predominantly through homosexual
contact, infection rates among heterosexuals were on the rise. Minorities
and marginalized populations—such
as intravenous drug users—were
especially vulnerable. And the disease
was making inroads into countries
once labeled as low-risk.

1986

Health Professionals Follow-up Study launched under
the direction of Professor Frank Speizer. A counter
part to the 1976 Nurses' Health Study, the study follows some 50,000 men—mostly doctors—and will
provide valuable evidence about the links between
lifestyle and cancer, heart disease, and other chronic
illnesses.

administered short-term, and are thus less costly, the regimen is
employable in places like Sub-Saharan Africa and Asia, where longterm drug regimens would be impossible to implement. Based on the
success of the 076 trial, new trials are now under way to determine if
lower doses of AZT could provide the same benefits, further lowering
the cost of treatments. Scientists and policymakers in Thailand, says
Lagakos, are awaiting the results of these trials before establishing a
national policy for testing pregnant women.
As for the new combination drug therapies, Lagakos describes
recent progress as "mind-boggling." SDAC recently cut short a
clinical trial (ACTG 320) of a combination therapy of AZT, 3TC, and
the protease inhibitor idinovir, when it became clear that the therapy
demonstrated true benefits. Earlier trials by a pharmaceutical company had shown the three-drug combination resulted in improved
marker effects, but SDAC's trial revealed an actual delay in disease
progression, driving down viral load to undetectable levels. The trials
have not yet shown how long the results will last, says Lagakos,
but if you can keep viral load undetectable for years, it can buy a
patient time until another drug might be available. "It's a big,

Within the A I D S research community, early hopes for a swift solution
had given way to the sobering
prospect of a long, arduous struggle
against a highly adaptable killer.
After the initial, promising burst of
discoveries about H i v , the pace of
research had inevitably slowed.
With each new finding, the puzzle
of H i v / A I D S seemed to grow more
complex. Every aspect of this seemingly simple organism—its sugarcoated outer shell, which cloaked it
from the body's defenses; its sloppy
reproductive apparatus, which generated a continuous series of new
mutations; the discovery of different
subtypes of the virus—favored its
continuing survival and spread.
Frustrated researchers stopped talking cures and vaccines and began

Space shuttle Challenger
explodes seconds after
launch.

calling for more basic research on
the virus itself.
In an effort to spur a new push
toward a solution to the crisis,
President Derek Bok and Dean
Harvey V. Fineberg convened a group
of A I D S experts from the School of
Public Health, the medical school, and
Harvard's afhliated teaching hospitals
to discuss how to integrate and
advance Harvard's diverse AiDS-related activities. "If we are to meet the
challenge of A I D S , " Fineberg said at
the time, "we must mobilize all the
intellectual and academic resources at
Harvard's disposal." The discussions
resulted in the creation of the Harvard
A I D S Institute, which drew together
the University's formidable body of
A I D S expertise included leading hguf^
in virology and vaccine research

Working with colleagues in Dakar, Senegal,
retrovirus expert Max Essex and colleagues Ric
Marlink and Phyllis Kanki discover a second
AIDS virus, HIV-2.

(Essex and Lee, the late Bernard
Fields of Harvard Medical School),
AIDS treatment (Massachusetts
General Hospital's Martin Hirsch, the
Deaconess Hospital's Jerome
Groopman, and others), epidemiology (Professor Nancy Mueller,
Marlink, Kanki, and others), molecular biology (William Haseltine and
Joseph Sodroski at Dana Farber
Cancer Institute), statistical modelling
and clinical trials design (Professor
Steven Lagakos and Associate
Professor Victor De Gruttola, s.D.'86)
and AIDS law and policy (Lawrence
Gostin, Harvey Fineberg, and the late
William Curran).
Officially unveiled in 1 9 8 8 , the
Institute, under Essex's direction, has
been a catalyst for research and training on AIDS. As hoped, the Institute's
creation helped accelerate AIDS
research across the university
(Harvard ranked hrst among academic institutions in the number of
Papers its researchers published on
AIDS between 1 9 8 8 and 1992.). The
Institute has also succeeded in focusing a t t e n t i o n o n AIDS a n d AIDS

research locally, nationally, and
internationally, through Institutesponsored lectures and forums and
conferencesâ&#x20AC;&#x201D;including large panel
discussions as well as informal,
brown-bag lunches. In addition, the
Institute has served as a bridge
between the academic world and the
broader public realm of AIDS activists
and advocates.

AIDS Action Committee (Acc),

^

Boston's leading service and advocacy
organization for people with A I D S .
Kessler also credits Essex, Groopman,
and other Boston-area physicians and
researchers with recognizing early on
the need to integrate clinical treatment
with the services offered through A I D S
Action's "social safety net" â&#x20AC;&#x201D;particularly in light of the few treatment
options available at that time. As the
disease has proliferated, the connection between the advocacy group and
the research institution has only
become stronger, says Kessler. Each
organization had something valuable
to teach the other. "While we learned
about immunology, the docs learned
about the psychosocial issues," says
Kessler. It was a relationship that
would also prove critical when volunteers were needed for clinical trials of
new drugs: Harvard researchers
turned immediately to AAC, whose
clients trusted the organization to
steer them in the right direction.

^ ^ ^ Hiv drug, AZT, was approved
^ ^ by the Food and Drug
Administration the demand for safe,
effective treatments had reached a
fever pitch. Desperate for answers,
people with A I D S demanded more
attention from government, scientists,
and the pharmaceutical industry, clamoring in particular for quicker access
to experimental drugs. In 1 9 8 9 , the
analysis of AIDS drugs received a big
boost when the National Institutes of
Health selected Harvard's Statistical
and Data Analysis Center ( S D A C ) to
analyze and interpret data from most
of the federally funded clinical trials
of AIDS drugs around the country.
Over the next eight years the center
would help analyze over 300 clinical
trials involving some 3 7 , 5 0 0 people
and provide critical insights about the
treatment of AIDS (see sidebar, 54).

"We don't even have to work
at it," says Kessler of A I D S Action's
continuing "good connection"
with the Institute and School. "It's
in the fabric of what we do."

^

Y 1 9 8 7 , WHEN THE FIRST ANTI-

By the early 1 9 9 0 s , the emerging
picture was that of a relentless
epidemic involving shifting demographics. Nearly 2.5 million people
had died from the disease, and
more than i z million people were
now infected with Hiv, a i z o - f o l d
increase from a decade earlier.

'From the very beginning, Dean
Harvey Fineberg saw AIDS as a public
health issue and believed that there
^as a role for the public health advocates," says Larry Kessler, executive
director and one of the founders of

Center for Health Communication established under
the direction of Jay Winsten, to provide reliable
health information to the public. The Center will go
on to launch the nationwide "Designated Driver"
campaign to reduce drunk driving fatalities.

Max Essex, chair of the Department of Cancer
Biology, receives the Albert Lasker Clinical
Medical Research Award for his pioneering
work in understanding the biochemical and
genetic characteristics of the AIDS virus.

Women now represented 40 percent
of the total A I D S cases. Experts were
describing the epidemic as "dynamic,
unstable, and volatile." While the
great majority of A I D S cases continued to be found in Africa, the United
States, and Latin America (90 percent
of all adult A I D S deaths to date), the
infection rate was rising dramatically
in Asia, where the disease had been
virtually unknown a decade earlier.
By the end of the century, experts
now warned, Asia could become the
epicenter of A I D S .
T w o events that took place in
1992. dramatically underscored the
need for international collaboration
in responding to the pandemic. The
first was the Eighth International
Conference on A I D S , co-sponsored
by the Harvard A I D S Institute. The
second was publication of
/M
WorM, the first effort to define
the epidemic's global contours, by
the School's Global A I D S Policy
Coalition.
The Eighth International A I D S
Conference will be remembered as
much for the political drama that
preceded the conference as for the
scientific material presented at the
conference. U.S. laws refusing entry
to HIV-infected individuals prompted
a showdown of sorts between the
Bush Administration and conference
planners, who threatened to move
the conference overseas if the laws
were not lifted. T w o years earlier, at
the Sixth International Conference
on A I D S , the normally soft-spoken
and reserved Essex had strongly
condemned the government's stand:
"This policy...threatens the free and
open exchange of information which
is critical to international efforts to

conquer the A I D S epidemic. There is
no sound public health justification
for these restrictions."
Ignoring appeals from activists,
academics, and foreign governments,
the U.S. government refused to lift
the ban, and the Institute, in partnership with the Dutch Foundation,
moved the conference to Amsterdam,
naming Jonathan Mann as conference chair. A I D S activists and the
international scientific community
cheered Harvard's principled stand.
A I D S Action's Kessler, whose organization had been involved in planning
the conference, says that while his
organization was excited to see the
world come to Boston for the conference, he supported Essex's decision
to move the conference to ensure that
people with A I D S would be able to
participate. Despite the eleventh hour
change of venue, the conference
drew more than 1 0 , 0 0 0 scientists,
clinicians, and activists, a remarkable
show of solidarity in the midst of a
mounting global crisis.
The full scope of this crisis was
brought into sharp relief with the
release of ALD5 w f^e WofM by the
School-based Global A I D S Policy
Coalition. Edited by Mann, Daniel
Tarantola, and Thomas W. Netter,
the book detailed, region by region,
the status of the pandemic and the
global response to it. Describing the
epidemic as "spinning out of control"
the report's authors predicted major
A I D S epidemics in Asia and Oceania
and projected that, by century's end,
as many as 1 0 0 million people would
be carrying the A I D S virus.
The publication, updated and
revised in 1 9 9 6 , helped crystallize
some of the key principles of

Under an a g r e e m e n t signed by Harvard President
Bok and Mexico's Minister of Health, the School
trains Mexican physicians to run primary health
care hospitals being established in the w a k e of
last year's earthquake, which killed 5,000 people
in Mexico City.

and related risk behavior to
larger societal issues. It also breathed
a new sense of urgency and purpose
into A I D S research. "We tried to
plead for an expansion of the
response to A I D S , " said Tarantola,
"to define what needed to be done
from a societal perspectiveâ&#x20AC;&#x201D;what
social interventions needed to take
place." The conceptual approach
found in both editions, said
Tarantola, was employed in two
important development efforts. As a
result of the publication, the United
States Agency for International
Development ( U N A I D ) moved from
looking at prevention to looking at
treatment issues, and the U N A I D S
(the Joint United Nations P r o g r a m m e
on H i v / A i D s ) strategy broadened
from condom distribution and A I D S
education and treatment into an
expansion of these strategies to look
at social issues.

Hiv/AIDS

nt

L M O S T I O Y E A R S A F T E R ITS

# % creation, the Institute contin#
^ ues to bring the research
conducted at Harvard and elsewhere
to bear on the epidemic and to c r e a t e
solutions for ending the epidemic.
Recent research yielded significant
information about H i v - i subtypes,
of which there are no less than 1 0 .
Essex's laboratory found that subtype
E, the cause of an explosive rise in
Hiv-infection in Thailand, is spread
very efficiently through heterosexual
intercourse, unlike subtype B, the
subtype found most frequently in the
United States and Western E u r o p e .
The Institute's search for a vaccine, under the leadership of P r o f e s s o r
Tun-Hou Lee, is also progressing.
Based on a process called " s e l e c t i v e

deglycosylation," in which sugar
molecules are selectively deleted from
g p i z o ' s surface, this work could
lead to vaccine trials within a year.
In editorials, Essex has continued
to push for development of a costeffective preventive vaccine that can
help relieve the growing AIDS burden
in developing countries.
But where the Institute continues
to do the most good, says Marlink, is
in the role of advocate—influencing
and pushing for important AiDS-related issues. A good example, he says, is
HAi's Madison Project, which helped
Ptopel the government to establish a
national AIDS research agenda. Under
the auspices of the Harvard AIDS
Institute, some of the country's leading AIDS experts, government officials,
and activists—including Essex, Larry
Messier, Robert Gallo, and National
Institute of Allergy and Infectious
Diseases head Anthony Fauci—assembled in two separate sessions in 1992.
to design a model for establishing a
national AIDS research program. The
group's work, says Marlink, provided
the incentive for federal action in
establishing the Office of AIDS
Research.
Today, Institute faculty are working to have the same impact on
vaccine research and testing in developing countries, one of the Institute's
highest priorities. The Institute recently held the fourth of six, three-day
long conferences, at which leading
^lDs researchers met to discuss strategies for developing a world-wide AIDS
vaccine, a project that Marlink says
combines two of the Institute's greatest strengths: its discoveries on the
basic mechanisms of the AIDS viruses the different subtypes and types—

^ c ' d population
^aches5billion.

First genetically
engineered vaccine,
against hepatitis B,
approved by FDA.

and its international collaborations.
Institute faculty are also concentrating on ways to curb the epidemic
in two of the United States' most vulnerable groups: African Americans
and young people. Today, the
African American community is
losing more of its young members
to AIDS than to any other cause of
death, before heart disease, cancer,
and homicide. With the help of
African-American leaders such
Henry Louis Gates, Jr., head of
Harvard's W.E.B. du Bois Center for
African American Studies, medical
school psychiatrist Alvin F.
Poussaint, and Children's Defense
Fund founder Marian Wright
Edelman, the Institute recently
launched Leading for Life, an educational campaign focused on stopping
the epidemic from making further
inroads into communities of color.
T o stem the tide of H i v infection
in America's youth (one-half of
all H i v infections in the United States
are in people under age 2.5), the
Institute recently teamed with the
Center for AIDS Prevention Studies
at the University of California at
San Francisco to convene a group of
youth-focused media and marketing
experts to develop new marketing
approaches to H i v prevention.
Together they discussed such strategies as condom advertising on cable
and network television and incorporating responsible sexual health
messages into him, radio, and
television programs geared toward
young people.
Less than two decades after the
hrst cases of A I D S were reported,
almost 6 million people have died
from the disease, one million of

whom were children. Approximately
2.2. million people are now living
with H i v or A I D S , and, last year,

^

over 3 million new Hiv infections

^

occurred. Some recent trends appear
encouraging: In some industrialized
countries, in parts of Africa, and
among some populations in
Thailand, Hiv prevalence is either
decreasing or stabilizing. AZT has
been shown to block a majority of
perinatal Hiv transmission. And new
combination therapies using powerful protease inhibitors have delayed
many deaths from A I D S . But the
battle against A I D S is far from over.
More than 90 percent of the people
affected by the disease cannot afford
existing treatments, and development
of vaccines to stop the disease's further spread is still several years away.

^

Until then, the School's researchers, faculty, and alumni will continue
their vanguard efforts, tracking the
epidemic, devising better prevention
strategies, uncovering the most effective drug treatments, searching for a
vaccine, and pushing to keep A I D S at
the top of national and international
policy agendas. As a principal player
in the A I D S effort over the last two
decades, Jim Curran, now dean of
Emory University's Rollins School of Public Health, sees the School's
contributions to curbing the epidemic as indispensable.
"From the dean down, the School
has provided important leadership in
controlling this disease," says
Curran. "From its public policy and
human rights work to its work in
the laboratory and AIDS modelling,
its contributions are i r r e f u t a b l e . " ^

Reactor explosion
at the Soviet nuclear
power plant in
Chernobyl,Ukraine,
is the worst nuclear
accident in history.

World Health
Organization launches
the Special Programme
on AIDS and n a m e s
Jonathan Mann,
M.P.H.'80, as director.

Harvey Vernon

Fineberg

D e a n ,

1 9 8 4 - 1 9 9 7

] n 1984, while serving out his final months as dean of Harvard's Faculty of Arts
! and Sciences, Professor Emeritus Henry Rosovsky began compiling a crashcourse in university administration for his successor. Later published as the essay
"Deanmg," Rosovsky's collection of anecdotes, caveats, and helpful hints offers a
witty glimpse into the intricacies of running an academic institution—a "peculiar
art," he wrote, for which few presidents, provosts, and deans arrive prepared.
The same year Rosovsky passed the baton of leadership
in Cambridge, across the Charles River a 38-year-old
health policy professor named Harvey Vernon Fmeberg
became the sixth dean of the Harvard School of Public
Health. The youngest, by a good decade, of all the
School's deans, Fineberg had only recently earned tenure
and his only administrative experience to date was a
three-year stint directing the School's Graduate Program
in Health Policy and Management.
On the other hand, few people could claim as intimate
a knowledge of the university as Fineberg. He'd been at
Harvard for two decades and held degrees from three
different university faculties. Under the tutelage of some
of the University's leading lights—including statistician
Frederick Mosteller, Kennedy School political scientist
Richard Neustadt, business school decision science guru
Howard Raiffa, and former H S P H Dean Howard Hiatt—
Fineberg had earned a reputation as an enterprising
scholar with a particularly wide intellectual
bandwidth.

1987

Lincoln Chen picked to
direct the 13-nation,
independent Commission
on Health Research for
Development.

"One of the things that's most impressive about
Harvey is the breadth of his brilliance. He has a gift
for thinking in other arenas," says colleague Milton
Weinstein, Henry J. Kaiser Professor of Health Policy
and Management, who, as a junior faculty member
in the 1970s, co-taught a course with Fineberg and
collaborated on several studies.
Among those who recognized Fineberg's intellectual
talents was former Harvard President Derek Bok:
"Harvey exemplified the kind of bold, energetic, young
scholar (former H S P H dean) Howard Hiatt had championed" during his tenure, tn the winter of 1 9 8 3 , shortly
after Hiatt announced his decision to step down as dean,
Bok asked to meet with Fineberg. Fineberg was expecting
to be asked who he thought should lead the School.
Instead, Bok offered Fineberg the deanship.
"In retrospect, one can see that it wasn't totally
out of character for him to turn to someone like me,
but it still struck me as quite stunning at the time,"
says Fineberg.

Professors Robert Geyer, Jere
Mead, and Frederick Mosteller
retire from the faculty of public
health. Professor Robert
Blendon succeeds Mosteller as
chair of the Department of
Health Policy and Management.

Fineberg, who had seen his friend
and mentor Hiatt buffeted by faculty
dissension during his tenure, had few
illusions about the potential pitfalls
of leading the School. While the internal furor had subsided, Fineberg, says
that his baseline expectation was that
his life as dean would be "filled with
noise and thunder." What he got,
however, was water—several million
gallons of it. Three months into his
deanship, and just 1 0 days before
the start of the 1 9 8 4 - 8 5 academic
year, the School's water main burst,
flooding the Kresge Building's lower
levels and causing massive damage
to Snyder auditorium, the building's
mechanical room, and several
administrative offices. Photos from
the time show wrecked offices,
damaged files and equipment, and
a patchwork of salvaged carpet remnants laid out to dry in the Kresge
courtyard. In weathering this baptism
hy water, Fineberg displayed a talent
for turning crisis into opportunity
that would serve him well throughout
his deanship.
"We worked day and night to get
the place ready for the students," he
recalls. " I remember standing in the
Kresge lobby the day before registration as they were repainting the walls
and putting on some finishing touches.
Suddenly, the father of a new student
came over, shook my hand, and told
me how impressed he was with all the
Polishing up we did, and the personal
attention that I was giving to it."
With equal diligence and aplomb,
Fineberg presided over a remarkable
Period of prosperity at the School during his 13-year career as dean. By any
objective measure—dollars raised,
growth in educational and research

programs, expansion of facilities—his
tenure has been a spectacular success.
When he took the helm, the School's
total budget was $ 3 5 million: in his
final year it topped $ 1 3 5 million. He
led the School into its first-ever capital
campaign, which so far has raised
more than $ 1 3 0 million and added 1 0
endowed professorships (bringing the
total to 30) and more than 1 5 0 , 0 0 0
square feet of new and renovated laboratory, office, and classroom space.
The centerpiece of this expansion is the
seven-story Fran$ois-Xavier Bagnoud
Building at 6 5 1 Huntington Avenue, a
keel-shaped edifice of polished granite,
concrete, and glass that is a fitting
monument to Fineberg's deanship:
efficient, contemporary, deftly blending form and function.
HE IMPRINT OF FlNEBERG'S

LEAD-

! ership also can be seen in the
myriad interdisciplinary centers and
programs that have arisen during his
watch—including the Harvard A I D S
Institute, the Harvard Center for
Cancer Prevention, the Center for the
Prevention of Cardiovascular Disease,
and the Harvard Center for Children's
Health—which, collectively, define
some of the most critical areas of contemporary public health research. He's
been particularly adept at steering the
School toward new areas of inquiry—
health and human rights, molecular
epidemiology, health communications,
and public health practice—that seek
to stretch the very boundaries of the
held.
"Harvey's very good at the 'wheeler-dealer' aspects of public health,"
says friend and former colleague
Barbara Rosenkrantz, professor of
the history of sciences emerita at

President Reagan and
USSR Party Leader
Gorbachev agree to
reduce stores of
medium-range nuclear
missiles.

Harvard. Mark Rosenberg of the
Centers for Disease Control and
Prevention, w h o has known Fineberg
for 2.7 years, says the driving force
behind Fineberg's success is his
"relentless optimism"and penchant
for "new, creative approaches" to
age-old problems.
In action, Fineberg projects the
unhurried authority of a man who
knows precisely where he's going and
how long it will take to get there. A
methodical and patient planner, he
manages to keep a sharp eye on the
details without losing sight of the big
picture. And while he prefers to leave
nothing to chance, he's able to shift
gears abruptly without breaking stride
when the situation demands it. " Y o u
get the impression that Harvey can
handle anything. He's equally composed whether the building's on fire or
he's getting an award," says Deborah
Prothrow-Stith, professor of public
health practice.
Fineberg especially excels at the
"toastmaster" aspects of deaning, his
genial wit and unforced eloquence
playing equally well in large lecture
halls and intimate dinner parties.
"Harvey's so charming, so erudite,"
says Weinstein. "He's never at a loss
for words, and he rarely makes mistakes." And whether through practice
or predilection, he has learned to strike
just the right balance of gravity and
hopefulness, urgency and assurance to
win broad-based support for a held
that has traditionally failed to capture
the public imagination.
In his rare free moments, Fineberg
relaxes by playing the piano and tinkering with computers. A self-confessed "techno-phile," he enjoys taking
his laptop out for a spin on the

Harvard Injury Control Center founded to
focus on reducing the 150,000 U.S. deaths
a year from injury.

^

zp^o's, Fme^erg prac^ceJ pMwo
LoweM NoM^e Tower roow.
Internet and has also tried his hand at
electronic composing. (Fineberg's wife,
Mary Wilson, says that if he could
choose any other profession, he'd
probably be a composer). And while
his professional demeanor is the
essence of level-headed discretion, he is
not without a waggish side. For his
sendoff from the faculty—billed as a
celebration of the occasion "Fineberg
Crosses the Charles"—Fineberg and
Wilson came costumed as George and
Martha Washington, powdered wigs
and all. And on a recent trip to Japan,
Fineberg purportedly sampled the
much-prized but occasionally lethal
delicacy known as /MgM—but only
after doing a quick risk-benefit analysis that took into account the chef's
reputation, the number of physicians
at the table, and the distance to the
nearest emergency room.

I second of three sons of Saul
and Miriam Fineberg, in Pittsburgh,
Pennsylvania, in the comfortable,
middle class neighborhood known as
Squirrel Hill. As a schoolboy,
Fineberg participated in the hrst trials
of the Salk polio vaccine, an experience he still vividly recalls. He came
to Harvard in 1 9 6 3 and has been here
ever since. As an undergraduate, he
lived in Lowell House, majored in
psychology, did thesis research on the
sleep habits of birds, practiced piano
in the Lowell House tower, and
played trumpet in the marching band.
By his junior year he had decided on a
career in medicine. (He confesses to
being unaware, at the time, that
Harvard even had a School of Public
Health.) Although by the time he
graduated, student protest had
reached a fever pitch—the following
year Cambridge police officers would
be called in to evict student activists
from University Hall—Fineberg's politics, in spirit and practice, were
shaped more by the constructive "ask
what you can do for your country"
ethos of the Kennedy era than by the
angry, anti-establishment mood of the
Vietnam War years. "We looked back
at the fifties as a time when students
were complacent and just looking to
get ahead in life," he says. " B y the
mid-sixties, hippie-dom had arrived
and people were dropping out. But for
my peers, the sense of liberation and
possibility was very palpable."
The turning point in Fineberg's
education came after his second year
at Harvard Medical School, when he
took a year off to participate in an
experimental public policy training
program at Harvard's newly re-chris-

tened Kennedy School of Government.
The program was developed and
taught by a faculty "dream team" that
included Mosteller, Neustadt, Raiffa,
game theorist Thomas Schelling, economist Francis Baton, and (as junior
course assistants) Graham Allison,
Richard Zeckhauser, and Henry
Jacoby. The program would introduce
Fineberg to many of the academic disciplines—statistics, economics, decision sciences, cost-beneht analysis,
and health-care policy—that would
underpin his subsequent career. In an
era when success in academic medicine was determined primarily by
one's laboratory pedigree, Fineberg's
request to take a year off to study
something as ephemeral as public policy raised eyebrows. He recalls explaining his decision to the dean of students, who sifted through Fineberg's
academic hie and said, somewhat perplexedly, "But your record here isn't
all that bad!"
(Despite the program's all-star cast,
Fineberg says that, at the time, public
policy was seen as such a fly-by-night
held that initially only students from
professional schools " w h o would have
a profession to fall back on if the
whole thing was a bust" were admitted to the program.)
Fineberg calls his time at the
Kennedy School "the most interesting, intellectually stimulating year
that I could have dreamed o f . "
Although he would go on to earn his
medical degree and practice as a primary care physician for 1 0 years in
two Boston-area neighborhood health
centers, his intellectual center of gravity already had shifted away from
treating individual patients to broader
questions related to improving the

Professor Tony Earls launches landmark study of
aggressive and antisocial behaviors a m o n g children
and adults in Chicago neighborhoods. The $20
million study will follow s o m e 11,000 people for
more t h a n a decade.

function of the health-care system as a
whole. As it happened, these were
some of the same questions on the
mind of Howard Hiatt, who became
dean of the School of Public Health
the same year Fineberg began his
medical internship at Boston's Beth
Israel Hospital. Hiatt recalls running
mto Fineberg one afternoon outside
of BI and listening as Fineberg
described his burgeoning interest in
society and health.
" I really wanted to work with
him," says Hiatt. " A n d I told him,
with the things you're interested in,
you should be at the School of Public
Health." After finishing his residency,
Fineberg accepted Hiatt's offer to join
the School as an assistant professor in
the Department of Health Services
Administration (later renamed the
Department of Health Policy and
Management). Over the next decade,
the two worked closely together, coauthoring one article, developing a
curriculum for training graduate students in health care policy, and collaborating broadly with colleagues in
the landmark Center for the Analysis
of Health Practices.
"I learned a great deal from
Howard, especially about the value of
interdisciplinary w o r k , " says Fineberg
today. " I was always inclined to it,
hut Howard (Hiatt), Howard Frazier,
and Fred (Mosteller) showed me how
to make it happen."
ERHAPS THE GREATEST SACRIFICE

* involved in Fineberg's accepting
the deanship was putting his scholarly
ambitions on the back burner. At the
t'me Fineberg was a rising star in the
School's Department of Health Policy
and Management. His research and

he anti-depressant drug
is introduced.

writing on the uses and effectiveness
of diagnostic technologies—including
the influential 1 9 7 9 N e w Ewgi^wJ
/oM7*7M/
article,
"Evaluation of medical practices; the
case for technology assessment," coauthored with Hiatt—had helped
launch the held of medical technology
assessment. He was a co-founder and
one of the first presidents of the
Society for Medical Decision Making
and had co-authored, with Weinstein,
the textbook Cfw/ca/ D<?c;'s;'o7?
Awfysz's.
Fineberg recently had gained
national repute as co-author, with his
former Kennedy School mentor
Richard Neustadt, of T^e
T ^ f Ne^gr
a brilliant analysis
of the decision-making process behind
the government's controversial 1 9 7 6
swine flu vaccination program.
The book was based on a confidential
study commissioned in 1 9 7 7 by
Secretary of Health, Education, and
Welfare Joseph Califano. Along with
Neustadt, Fineberg interviewed many
of the principals, including poliovaccine pioneers Jonas Salk and
Alfred Sabin, both of whom endorsed
the swine flu program, and Centers
for Disease Control Director David
Sencer, M . P . H . ' ^ 8 , who initiated the
program and ultimately took the
blame for its failure.
The report's initial release in 1 9 7 8
had provoked a squall of controversy
within the public health community.
Some influential persons objected to
the book's characterizations and conclusions and accused the authors of
undermining future preventive vaccine
programs. Among the most vocal
critics, says Fineberg, were the deans
of the nation's schools of public

Former Surgeon Genera!
and Project Head Start
founder Julius Richmond
retires from the
Department of Health
Policy and M a n a g e m e n t .

health. For his part, Califano says
Fineberg and Neustadt did a "fantastic j o b " of maintaining objectivity
and drawing critical lessons from the
program's failure. "Nothing like it has
been done in public health since," he
says.
Califano especially praises
Fineberg's ability to "instantly grasp
the difficulty of making decisions in
a political context." (Interestingly,
neither the Swine Flu report nor its
authors were anti-immunization;
indeed Fineberg went on to be something of a champion of immunization.
In 1 9 9 0 - 9 1 he co-chaired an Institute
of Medicine panel that studied
the safety of pertussis and rubella vaccines and concluded that the slight
risk of adverse reactions to the vaccines was outweighed by their broader benefits in preventing childhood
disease.)
Fineberg has continued to publish
at a prodigious pace since becoming
dean—some 30 scholarly articles, 5
books, and more than a dozen editorials and book chapters in all—a truly
remarkable output given the hectic
schedule a dean must keep.
"Harvey has the ability to block
out all distractions and focus completely on what he's doing," says
Wilson. "Even on a crowded airplane,
he can just sit and work as if nothing
else were happening."
N o account of Fineberg's career
would be complete without mentioning the special partnership he shares
with Wilson, his sometime collaborator and wife of
years. A native of
Indiana and former graduate student
in English literature, Wilson is chief of
infectious diseases at Mount Auburn
Hospital in Cambridge and a faculty

member in the Departments of
Population and International Health
and Epidemiology.
They met in 1 9 7 1 while doing their
residencies at BI (as a second-year
resident, Wilson was his superior) and
dated for a couple years before getting engaged. In the spring of 1 9 7 5 ,
in the midst of planning a wedding on
Cape Cod, they were invited to join
a medical delegation on a 2.2.-day tour
of the People's Republic of China—
one of the hrst groups of Westerners
allowed into the country since the
onset of the Cultural Revolution. On
the last leg of the trip, while waiting
out a four-hour layover in the
Shanghai airport en route to Canton,
one of the Chinese guides turned
to Fineberg and asked if he were
married. (Fineberg says this was the
hrst time during the journey that any
of the guides had asked any personal
question of their guests.) Fineberg
replied that he was unmarried, but

engaged to marry the woman sitting
next to him. "In fact," Fineberg
continued in an uncharacteristically
impulsive way, "if we could, we'd
love to be married here in China."
("We'd never even discussed it," says
Wilson.) A few days later members
of the delegation arranged a wedding
ceremony at the hotel in Canton.
The Chinese hosts provided a cake
and a silk wedding scroll. As part of
the celebration, the newlyweds were
asked to sing a song to their hosts.
Uncertain what would be appropriate
in communist China, the couple
serenaded the group with "I've Been
Working on the Railroad."
In recent years, Fineberg and
Wilson have collaborated on a series
of studies of the effectiveness of BCG
vaccine in controlling tuberculosis.
They have also co-authored articles
on the social dimensions of disease
and the risk to travelers of contracting
AIDS.

Bt^MOMjBMMw^
owe o/^f^e cap^OMM

France and China
authorizeuseof
steroid drug RU-486,
also known as the
"morning after" pill,
as an abortifacient.

FTER THE FLOOD THAT CHRIS-

tened his deanship, Fineberg
turned his attention to a more subtle
challenge facing the School: what
marketing consultants would call an
identity problem. Both within the
faculty and out in the general public,
says Fineberg, there was little consensus about what pubhc health was
and, by extension, what schools of
public health should be doing. "When
I hrst became dean, I remember
wondering, 'What was the mission?
Where was a succinct statement of
what we were all about?'" he says.
Since then, Fineberg has devoted
a considerable part of his time and
energy to articulating a common
mission and set of objectives for the
School and, by extension, for public
health as a held. It wasn't easy.
Fineberg says that "just getting his
arms around everything that was
going on at the School" was a challenge. He wisely enlisted the faculty
to help define the School's priorities
by instituting annual faculty retreats,
and he beefed up the School's internal
and external communications efforts.
Most importantly, he relentlessly
reasserted his message in print,
speech, and conversation. " I wanted
it so you could take anybody in the
School, wake them up in the middle
of the night, and they could blurt out
the School's mission," he says. This
may seem a modest objective, but at
an institution where molecular biologists, physicians, economists, and
statisticians tended to regard each
other with mutual incomprehension,
a single, shared phrase—advancing
the public's health through learning
and discovery—provides a critical
thread of cohesion and coherence.

New York state d o s e s
15milesofbeachdue
to medical waste,

Of course, mission statements,
however apt, are oniy part of the
institution-building formuia; equally
important is a compelling cause
around which to rally. For public
health in the past decade and a half,
that cause was acquired immune
deficiency syndrome ( A I D S ) , whose
sudden appearance and rapid spread
in the 1980s exposed the limitations
of curative medicine, reinvigorated the
concept of disease prevention, and
brought a flood of attention and funding to schools of public health (see
article, page 50). Few scholars have
become as involved in the struggle
against A I D S on as many fronts as has
Fineberg. T o date, he has authored or
co-authored 1 1 articles, 3 editorials,
one book, and 5 book chapters on
diverse aspects of the A I D S epidemic
tanging from the ethics of compulsory
Hiv testing to the effectiveness of
bleach programs in preventing A I D S
transmission among iv drug users.
Most of these are polite scholarly
tracts written for fellow scientists; but
one, a 1 9 9 1 N e w York Times editorial
decrying the government's decision to
bar Hiv-infected travelers from entering the country, contains what, in academic circles, might be called fighting
Words. Dismissing the idea that the
Policy had any public health benefit,
Fineberg wrote that "the real reasons
behind the exclusionary policy
are...irrational fear, misunderstanding
and prejudice, salted by political
opportunism and cowardice."
Fineberg says that any public
health dean during the past 1 5 years
^ o u l d have had to contend with A I D S .
It Wasn't exactly a hard call," he
says. But few would have taken it up
as a personal cause, as he has. He's

been on the board of directors of the
American Foundation for A I D S
Research since 1 9 8 6 and has served
on AiDS-related advisory committees
at the Centers for Disease Control and
Prevention, the Institute of Medicine,
and the U.S. Agency for International
Development, among others. He's
been especially active in Mexico,
where he has worked with H S P H
alumnus Jaime Sepulveda, S . D . ' 8 $ ,
in drafting a national A I D S policy.
Fewer still would have had the insight
and influence to mobilize a universitywide response to the disease, as
Fineberg did when he launched the
Harvard A I D S Institute in 1 9 8 8
(see article, page 50).
At the same time he aggressively
confronted A I D S , Fineberg also broadened hisâ&#x20AC;&#x201D;and the School'sâ&#x20AC;&#x201D;horizons
on numerous fronts. With the late
Sol Levine, former H S P H Professor and
current Wellesley College President
Diana Chapman Walsh, and new
department chair Lisa Berkman, he
reinvigorated the School's Department
of Health and Social Behavior. He
was instrumental in garnering support
for the Frangois-Xavier Bagnoud
Center for Health and Human Rights,
which, under the direction of
Professor Jonathan Mann, M.p.H.'8o,
has sought to redefine the relationship
between human welfare and human
rights. His most telling project for the
School may be the Division of Public
Health Practice. Launched in June
during Fineberg's final month as
dean, the Division, under the direction
of Prothrow-Stith, will promote
collaboration between the faculty and
students at the School and the many
community-level agencies that underpin public health. A fitting capstone

Project LIFE is a collaborative effort b e t w e e n
the School and the surrounding Mission Hill
community to reduce the community's high
infant mortality rates.

to Fineberg's career, this schoolwide effort symbolizes his ideal of an
institution dedicated equally to

63

scholarship and service in pursuit of
global gains in health.
"In my last year at Harvard, I
spent a day meeting with faculty and
students at the School of Public
Health," says Bok. "It was a very
exciting day. I had the impression of
a range of problems being addressed
with great enthusiasm and vigor.
The feeling of shared commitment
was tremendous."

^
y

On April 3, 1 9 9 7 , Harvard
President Neil L. Rudenstine
announced his selection of Fineberg
as University Provost. The appointment, applauded by faculty, graduates, and administrators at the
School, marked the end of Fineberg's
13-year term as dean. Fineberg knows
enough about "deaning" to give his
successor a wide berth in which to
develop his own agenda and vision
for the School. But one senses that
he also is confident that the imprint
of his leadership is likely to remain
visible for some years to come.
"I've tried to not so much instill
as liberate the concept that we're
simultaneously doing scholarship and
practical work, and to help people
understand how what we're doing
here at the School makes a difference
out in the world," says Fineberg. " A s
you look around at all the work being
done today, I feel that this faculty is
living out its mission."

Building i had grown into a standing-room-only crowd. Students and faculty
were feeling the intellectual equivalent of an adrenaline rush. The idea under
discussion was really quite an old one: that changes in the world's ecology can
lead to changes in the diseases that afflict the people who inhabit it. But with
Hiv-AiDS,

the Ebola virus and the global rise in tuberculosis all in the news,

there was a new urgency to the subject. Some of the School's most dynamic
and accomplished faculty were in attendance. Among the most striking was an
older man with a wise mien, snow-white hair and beard, and a weathered face.
When he spoke, recalls Mary Wilson, that Richard Levins was truly impressive.
" I would sit there sometimes with my mouth open in awe," says Wilson, an
assistant professor in the Departments of Population and International Health
and Epidemiology. "He would move so easily, so seamlessly, from economics
to molecular genetics to political theory to biology. He pulled it together
so effortlessly and then would bring in some very practical observations."
For over two decades, Levins, the John Rock Professor of Population
Sciences, has been one of the intellectual giants of the School. A founding
theoretician of evolutionary ecology and one of the world's most brilliant

d i a t e c t i c s of d i s e a s e

1989

James 0 . Mason, D.P.H.'67, named assistant secretary for health in the U.S. Department of Health
and Human Services. Donald Hopkins appointed
acting director of the CDC.

biomathematicians, Levins has
applied ideas from these fields to
the problems of disease causation,
particularly infectious disease. In
over-simplified terms, he is a scholar
of, and advocate for, an ecological
approach to public health.
The 66-year-old professor says this
approach is partly a matter of taste:
"There are different aesthetics in
science. Physicists have an aesthetic
for symmetry and simplicity. M y own
aesthetic is for complexity, anomaly
and, asymmetry." Levins' scientific
views are also guided by a philosophical outlook rooted in Hegel and
M a r x that eschews the modern
tendency to break systems into their
smallest identifiable parts. Instead,
Levins sees the world as an evermoving process and looks for patterns in the whole.
"When someone asks me what
Richard specializes in, I answer,
'complex systems,' " says Pamela
Anderson, s.M/84, s.D.'c<i, a
Colombia-based researcher and consultant in the School's Department of
International Health and Population
Sciences and someone who has prized
Levins as a mentor for a decade.
"Problems in health, agriculture, and
the environment all span disciplinary
boundaries and require the integration of biological and social phenomenon," says Anderson. "Richard
applies his integrated, quantitative,
and qualitative thinking on complex
systems to all these arenas."
Levins grew up in Brooklyn's
Manhattan Beach section, a comfortable middle-class neighborhood just
^ast of Coney Island, but he was
*nrtbued with a radical socialist outtook at a young age. His great-great

t WUIONAL
K
iNWfUTE

grandmother rebelled against the
orthodox Judaism of her day on the
grounds that it was sexist. His father,
an attorney, was a member of the
Young Communist League. As an
eight-year-old, Levins set out to raise
money for the Abraham Lincoln
Brigade, a contingent of left-wing
Americans that fought in the Spanish
Civil War.
"It was an interesting experience,"
he says, a smile creeping across his
face. "After the hrst meeting or two,
we realized that we had no resources
for actually contributing to the
Abraham Lincoln Brigade and furthermore, we were dependent on our
parents for transport." Levins laughs.
" S o I decided at that point that a
political movement needed a material
base!" Levins says he grew up "with
the sense of the inseparability of
science and politicsâ&#x20AC;&#x201D;that is, trying
to understand the world in order to
change it."
S AN U N D E R G R A D U A T E AT COR-

^ T ^ nell, Levins split his studies
between math and genetics. An active
member of the Communist Party,
Levins figured opposition to his
radical politics would block a career
in science. "It was the McCarthy
period, and I expected the United
States to become more repressive and
fascistic," he says. So after he graduated, Levins and his wife, Rosario
Morales, moved to her native Puerto
Rico to farm and work as labor
organizers.
The 90-acre vegetable farm in the
midst of coffee plantation country in
the island's Central Mountains was
"technically innovative, but barely
getting by economically," says

National Cancer Institute a w a r d s $3.2 million
to Professor of Radiobiology John B. Little to
study health effects of ionizing radiation.

Levins. He and his wife had seed sent
from all over the world. They used
some novel agricultural methods. But
two children made the micro-economics of the farm that much more
precarious. Sick in bed with hepatitis,
Levins began to look over his old
math notebooks and decided that
maybe he could contribute something
to science. In 1 9 5 6 he returned to
N e w Y o r k City as a graduate student
in Columbia's zoology department.
His family still owns the farm
in Puerto Rico, but termites have
claimed the farmhouse, and the
original 90 acres has shrunk to 35.
Zoology, and the life sciences
more generally, was in the throes of a
titanic struggle as Levins resumed his
studies. After Watson and Crick
described DNA's structure in 1 9 5 3 ,
biology based on held work and
observation was being increasingly
dismissed as old hatâ&#x20AC;&#x201D;unimaginative
"stamp collecting" as Harvard's
Edward O. Wilson described it in his
1 9 9 4 autobiography. The way to
understand living things, said the upand-comers, was at the molecular
level, through genes and biochemistry.
Meanwhile, scientists such as
G. Evelyn Hutchinson at Yale and
Robert MacArthur at the University
of Pennsylvania were headed in the
opposite direction. Their biology
sought to describe life at the population level, and how those populations
compete with and compliment one
another in an environment.
Moreover, they wanted to find
underlying mathematical patterns to
these inter-species and environmental
relationships. With his mathematical
gifts and knowledge of genetics,

Ebola virus kills 60
monkeys in a Virginia
laboratory, the fist
known Ebola outbreak
in the U.S.

Levins was a weicome addition to this
new held, known variously as population biology, population genetics, and
evolutionary ecology.
Levins hrst major contribution to
this new population-level biology was
development of the community
matrix, a mathematical model for
determining how many overlapping
species can co-exist in a shared environment. Levins says he developed the
community matrix model after a
series of intense scientihc discussions
with MacArthur at a meeting on
mathematical biology held at Yale in
the early 1960s. The community
matrix can be thought of as a table in
which the rows and columns are
species and other elements of an environment and the entries are calculations for describing the interactions
among them. It can be used to derive
some of the essential ecological features of an environmentâ&#x20AC;&#x201D;its stability,
its sensitivity to change, its vulnerability to catastrophe. Levins eventually
trumped his own model with loop
analysis, which also deals with species
interaction in an environment.
More generally, Levins helped
change how modern biology views the
environment from something that was
objective, uniform and largely static
to a system that is "selected, transformed, and dehned" by organisms.
Richard Lewontin, the Alexander
Agassiz Professor of Zoology at
Harvard, who has known Levins for
3 5 years, says Levins has supplied
modern biology with the insight that
"there is no element of the environment that is not a consequence of the
organisms that construct it."

Levins was a professor at the
University of Chicago before coming
to the School in 1 9 7 5 . Over the years,
Levins has challenged his students
and his colleagues to view disease in
ecological terms rather than settling
for standard etiologic explanations.
In a class, he might ask students to
calculate how a gene that increases
the nitrogen uptake of wheat plants
might affect the economic independence of women. His admirers say
one of the amazing things about him
is that he often has answers to just
that kind of question. "He makes
connections better than anyone I
know," says Lewontin.
H

HILE AT THE SCHOOL, LEVINS

W W has kept his hand in biology,
writing articles for
QM^r^r/y
RsM^w o^B;o/ogy and elsewhere.
Integrated pest management, which
seeks to minimize the use of pesticides, has been a practical interest.
He travels frequently to Cuba, where
he has taught, conducted research,
and advised government officials on
agricultural practices. And he still
proudly wears the label communist
(to show people, he says, that "we are
still around and kicking.") "Dick
Levins has a very gentle and generous
spirit," says Mary Wilson. "I have
never seen him be mean or sarcastic."
Pamela Anderson says, "He is a
true intellectual; he listens to others
and he engages their ideas, irrespective of the source."
That Levins would have interest in
new and emerging diseases is only
logical. After all, to an evolutionary
biologist, a pathogen is just another

species seeking a safe haven for life
and reproduction. Levins was a key
participant in the pivotal Woods Hole
meeting in November 1993 that gave
fresh currency to the notion that environmental changes resulted in new
opportunities for pathogens. Levins
says he is delighted at the public
attention that new disease research
has gotten as it has put to rest the
notion that infectious diseases have
been conquered. Working with his
close colleague Tamara Awerbuch, a
lecturer in the Department of
Population and International Health,
he is in the midst of a Robert Wood
Johnson Foundation-funded study
asking why public health was caught
off-guard by the emergence of diseases
like Lyme disease and A I D S .
Drawn to science by politics and
philosophy, Levins has the serenity of
someone who has been true to his
beliefs. As a young man, he says, he
found his "intellectual focus" in
dialectics, Marxist philosophy, and
"a fascination with complexity." And
his most recent causeâ&#x20AC;&#x201D;the need for an
"integrated epidemiology" that would
take into account the myriad causes
and effects that result in diseaseâ&#x20AC;&#x201D;resonates with ideas that a boy from a
radical family in Brooklyn was introduced to about a half-century ago.
"Something is not quite right in the
way our species' current societies are
relating to the rest of nature or in the
way we attempt to fix what goes
wrong," Levins has written recently"There is a disjunction in science
between the exquisite sophistication
of the small and the irrationality of
the enterprise as a whole."

Peter Wehrwein

Nurses Health Study I! launched under the direction
of Professor of Epidemiology and Nutrition Walter
Willett. A complement to the original Nurses' Health
Study, NHS II enrolls 116,000 young women.

National Institutes of Health selects the
Department of Biostatistics as the Statistical
and Data Analysis Center (SDAC) for all federally
funded clinical trials of AIDS drugs. Directed
by Professor Stephen Lagakos, SDAC will produce
some of the most important findings about
individual and combination drug treatment.

hea!th
numbers

MARViN ZELEN

"

jj '

H E S E D A Y S , E V E R Y T R I A L OF A NEW D R U G OR S U R G I -

erative group studies," says Professor of Biostatistics

cal intervention is closeiy scrutinized by a statistical

Richard Gelber. In doing so, Zelen played a key role in the

"consultant." But before Marvin Zelen came along,

development of cancer treatments that have, just to cite

biostatistics had something of a Rodney Dangerfieid problem: it rarely got the respect it deserved.
"Years ago, clinical trials were often the sole province

one example, vastly increased the chances of surviving
leukemia. Many of the lessons learned in cancer clinical
trials were subsequently applied to

AIDS

clinical trials,

of surgeons and clinicians," says Professor of Biostatistics

including Gelber and his colleague's landmark study

Stephen Lagakos. " M a n y of them didn't view a clinical

showing that AZT can cut the chances of transmission of

trial as what it is—a scientific investigation—and few

Hiv from an infected mother to her baby by two-thirds.

appreciated the importance of statistics."
Nobody in this country has done more than Zelen, the

Throughout his career, Zelen has been a fighter and
defender as well as an intellectual force. "I think I have

from the optimum formation for
groups of bomber planes to the
best way to search for submarines.
(Another former chairman of the
School's biostatistics department,
Frederick Mosteller, was a member
of an elite group of Princeton mathematicians whose understanding
of sampling procedures helped the
government answer questions like
whether an Army base would overtax
a local public transportation system.)
The federal government established
two large applied mathematics
laboratories after the war, one at the
National Bureau of Standards in
Washington and the other at U C L A .
After earning a masters degree in
statistics from the University of
North Carolina (Chapel Hill) in
1952., Zelen was hired by the
National Bureau of Standard's
Statistical Engineering Laboratory,
which was part of the National
Applied Mathematics Laboratory.
For Zelen, those 1 0 years at the
Bureau are a delightful memory. At
age 2.$, he says he was the "baby of
the group" and one of the few people
without the imprimatur of a PH.D.
(which he remedied in 1 9 5 7 by
taking evening classes at American
University). Zelen thrived in the lively,
intellectually rambunctious atmosphere of the Bureau. Zelen says he
pursued some theoretical problems,
but also gained the invaluable experience of designing research projects
up front so that when the results came
in they would pass statistical muster.
His first real taste of biostatistics came
in the early 1960s when Zelen was a
visiting professor at the University of
Wisconsin's Mathematics Research
Center. Asked to work out a statisti-

1990

The Berlin Wall falls as
Germany is reunited
and the Soviet Union
crumbles.

cal problem related to a trial of a
childhood leukemia drug, Zelen and
his collaborator George Weiss
came up with something called the
semi-Markov process (Markov was
a Russian mathematician), which
now stands as one of Zelen's prime
contributions to the biostatistical
canon. Essentially, the semi-Markov
process is a statistical model used for
both calculating "sojourn time," or
how long a patient might stay in a
certain "phase" of cancer treatment
(say remission or relapse) and using
that sojourn time to predict the next
phase the patient will go through.
N o w dedicated to biostatistics,
Zelen was invited to head the
National Cancer Institute's Applied
Mathematics and Statistical section
in 1 9 6 3 , where he immersed himself
in cancer and clinical research for
the next four years. After a year in
London as a Fulbright Scholar, he
was lured back to academe and into
the arms of the State University of
New York at Buffalo. Zeien spent the
next decade on the snowy eastern
shore of Lake Erie effectively inventing the biostatistics that make possible today's sophisticated clinical
testing of cancer, A I D S , and all kinds
of other treatment drugs. Zelen says
he wasn't happy dispensing advice
to his NCI colleagues. " I decided it
was important to have some kind of
demonstration project to show how
things could be done," he says. So
he formed the Statistical Laboratory
at the University of Buffalo.

<

HE STATISTICAL LABORATORY

was a master stroke. Zelen saw
that the statistical aspects of
the large, complex trials of treatment

drugs needed to be more centrally
administered, particularly when it
came to treatment assignments and
randomization. Leaving treatment
choice to clinicians and treatment centers created too many opportunities
for cutting corners, steering certain
patients to certain treatments, and
robbing randomization of its randomness. "There were a lot of complaints
in the beginning," Zelen says. "People
would say, 'We used to hold the
sealed envelope up to the window to
see what the treatment would be, and
now we can't do that anymore.' " He
also saw that poor record keepingâ&#x20AC;&#x201D;
what would be today called data
managementâ&#x20AC;&#x201D;was undermining high
quality research. Untrained secretaries
were often left in charge of reviewing
patient records and filling out the
forms for a study. Proper training and
some "pretty smart people" were
needed to do the job right, Zelen
believed, so he created a new job and
called it "data manager" because
managers are paid more. "We made
data management into a profession,"
he says. "There was really no point in
applying sophisticated statistical techniques to data that was garbage."
The emergence of the large, multicenter randomized clinical trial also
posed some new statistical challenges.
Zelen designed "dynamic randomization" techniques so that a roughly
equal number of patients would be
allocated to each treatment option
under study. He also wrote one of the
hrst papers on adaptive design of clinical trials, a novel randomization
strategy that would have an investigator stick with a treatment until it fails
and then switch over to the alternative. Zelen also did some ground-

Enrollment reaches
530 students, up from
230 in 1970.

breaking work in the heid of survival
analysis that preceded Sir David
Cox's proportional hazard model,
a mainstay of contemporary
biostatistics.
Meanwhile, Zelen was building
SUNY-Buffalo into a clinical trials
juggernaut by getting grants from NCI
and attracting young, smart statisticians and mathematicians. For 1 9
years, Zelen was the top statistician
in the Eastern Cooperative Oncology
Program ( E C O G ) , which becameâ&#x20AC;&#x201D;
partly because of Zelenâ&#x20AC;&#x201D;the largest
program in the world for testing
various cancer treatments.
By the mid-yos, Zelen was prominent enough to capture the attention
of Mosteller, who, at Dean Howard
Hiatt's request, had come to the
School with the express purpose of
building up the biostatistics department. In his negotiations with the university and the School, he asked for
just a little more than usual. " I said I
would like 1 0 faculty appointments in
addition to my own. They were used
to hiring faculty. They weren't used to
hiring a basketball team," says Zelen,
adding that he believed bringing the
"team" with him to Boston was
essential to the viability of ongoing
clinical trials. When Zelen came to
the School in 1 9 7 7 , he brought with
him an entourage that included 1 0
faculty members, 1 7 non-faculty
members, a huge DEC 2.0 computer
(they had to knock down a wall to
ht it into the basement of the DanaFarber's Jimmy Fund building) and
1 5 0 cancer trials involving several
thousand patients.
Zelen succeeded Mosteller as chairman of the biostatistics department in
1 9 8 0 and held the post for 1 0 years.

Cancer Causes ancf Confro/, edited by professor of
epidemiology emeritus Brian MacMahon, is the
first major scientific journal to be published out of
the School.

He kept the E C O G trial work going
(Professor Dave Harrington has
replaced Zelen as the lead statistician)
and laid the groundwork for the
department's pre-eminence in A I D S
clinical trials, now manifest in the
Center for Biostatistics in A I D S
Research ( C B A R ) . He beefed up the
biostatistics curriculum. When one
leading professor at the School
expressed puzzlement, tinged with
disapproval, that there could be that
much to teach in biostatistics, Zelen
says he answered, "We have only
just scratched the surface!" Lagakos
says Zelen "really made this department into a wonderful place," fostering creativity and confidence in his
colleagues. " H e made you feel like
you could do anything."
] N T H E E A R L Y 1980s, T H E W I D E R
j world caught a glimpse of Zelen's
' tenacity. Flying in the face of conventional wisdom that such a study
could ever produce significant results,
Zelen, with Lagakos's help, launched
an investigation of the connection
between what seemed to be a cluster
of childhood leukemia cases in the
Boston suburb of Woburn, and the
town's contaminated water supply.
Three years later, the Harvard Health
Study, as it came to be known,
showed for the hrst time a connection
between Woburn's contaminated
water supply and a variety of adverse
health effects, including leukemia. As
described in A Cwz'/ AcH'oM, the bestselling account of the lawsuit that
grew out the Woburn cancer cluster,
when Zelen announced the study's
results in the basement of a Woburn
church in February 1 9 8 4 , someone in
the audience said "Thank God for

Marvin Zelen." The crowd burst into
applause. A hero to those Woburn
parents, Zelen and his study were

69

attacked elsewhere. In fact, the chair
of the School's own epidemiology

^
^

department, Brian M a c M a h o n , was
sharply critical of Zelen and Lagakos
for what he said was an over-interpretation of their data. But Zelen didn't
waiver. " H e champions the underdog," says Lagakos. " A n d if he feels
something is wrong, he doesn't worry
about getting in trouble."
In 1 9 9 0 , Zelen stepped down as
chairman of the department, but
he continues to be a presence at the
School, teaching, attending seminars,
and supervising post-doctoral
students. His fourth-floor office at
Dana-Farber overlooking busy
Brookline Avenue has the delightful
aura of the active, accomplished
mind: the haphazard photos of family
and colleagues, an eclectic collection
of academic journals and textbooks,
the desk and tabletop choked by a
shifting layer of papers and correspondence. N o longer involved in the
day-to-day running of clinical trials of
cancer treatments, Zelen has started
thinking about how cancer screening
studies could be improved, diplomatically describing the current approaches as "suboptimal." And though his
back-of-the-candy-shop, card-playing
days in the Bronx are long gone,
Zelen has given a friend some statistically-based advice on how to play
one of the biggest games of chanceâ&#x20AC;&#x201D;
mutual fund investment. Zelen's tip
is to "play the winner": stick with the
biggest gainer until it is surpassed,
and then switch to the new leader.

Peter Wehrweirt

South African political
resistance leader Nelson
Mandela is released from
prison after 27 years.

! crucial time in his life, a time when everything he had
believed up to that point suddenly seemed incomplete, even skewed. Speaking quickly, eloquently, he
describes events 1 3 years and over 5,000 miles removed

course. In Uganda, for instance, a married woman who
refused to have sex with her husband risked divorce
and economic disasterâ&#x20AC;&#x201D;even if she knew her husband was
infected.
Mann asked himself: "What are the barriers to her

the re-awakening of public health's political conscience.
of the Frangois-Xavier Bagnoud Center for Health and

disease to recognize and treat the poverty and other social

Human Rights at the School of Public Health. Under

factors that underlay so much human misery. Virchow's

Mann's leadership from 1992. to 1 9 9 7 , the center has been

beliefs were later echoed in the slogans and practices of

the academic focal point for a broad-based movement that

the sanitary reformers w h o gave birth to modern public

seeks to unite two previously distinct enterprises: public

health.

health and human rights. Inherent in this new paradigm is
the notion that public health research and practice must

In an interview for T^g People's
He^M? a w J f f s Et^ofM^'ow af

A

o/^
Barbara

actively engage political and social injusticeâ&#x20AC;&#x201D;a notion that

Rosenkrantz, professor of the history of science emerita,

many public health traditionalists balk at. And yet, Mann

told author Robin Marantz Henig, that early on "public

and others point out that the roots of this radically " n e w "

health was closely allied to social reform, openly, without

vision for public health are, in fact, more than a century

any apologies." Examples of this alliance between health

old. " W e are heirs to a tradition that goes way back to the

promotion and social activism abound. Legendary
Harvard epidemiologist Alice Hamilton was an unabashed

beginning of public health," says Mann.
One of the first to view health through the lens of politics was German pathologist Rudolf Virchow, the popularized patron saint of public health, who in 1 8 4 9 stirred
the placid waters of European medicine by challenging his
fellow physicians to look beyond clinical manifestations of

Smoking is banned on
U.S. domestic airline
flights.

socialist who joined in the international protest over the
executions of suspected anarchists Sacco and Vanzetti.
Martha M a y Eliot, chair of the Department of Maternal
and Child Health and long-time director of the Children's
Bureau, was influential in lobbying for federal programs

Jonathan Mann, M.P.H.'80, leaves the WHO's Global
AIDS Programme, to join the School as professor of
epidemiology and international health.

Harvard Center for Risk
Analysis founded under
the direction of
Professor John Graham.

DMHMg ^/s S years
OM ^ e
Maww, M.P.H.'8o,

for poor mothers and children. And
famed Yale epidemiologist CharlesEdward Amory Winslow called
for "the development of the social
machinery which will ensure to
every individual in the community
a standard of living adequate for
the maintenance of health."
Yet, notes Rosenkrantz, this
activist edge gradually was tempered
by the rise of a more empirical brand
of public health that viewed social
reform as "subjective, politically
tainted." By the end of World War II,
scientihc advances had given rise to a
technology- and biomedicine-based
public health paradigm focused more
on combating pathogens and vectors
than on addressing the broader social
context in which they proliferated.
Government funding for basic
research on vaccines and antibiotics
blossomed. The pesticide DDT was
the primary weapon in the international malaria control efforts of the
1950s and 1960s. Medicine, meanwhile, had become big business, and
doctors defenders of the status quo.
In 1948, the American Medical
Association, exploiting the prevailing

1991

A poll of HSPH students by faculty member David
Hemenway reveals that 9 7 % are non-smokers, 9 6 %
support legalizing abortion, 8 9 % wear seatbelts, and
75% support national health insurance.

anti-Communist sentiment of the
day, helped defeat President
Truman's effort to institute a national health insurance program by
branding it "socialized medicine."
But even as biology and technology assumed center stage in this brave
new era of public health, other forces
were paving the way for a new brand
of political consciousness. The sheer
carnage and suffering unleashed by
the Second World War led to the creation of a new global humanitarian
doctrine: the Universal Declaration of
Human Rights. Adopted by the U.N.
General Assembly in 1948, the declaration asserted the "inherent dignity"
and "equal and inalienable rights and
fundamental freedoms of all members
of the human family" and launched
an international movement to protect
and promote these rights. And the
Cold War that followed raised the
specter of man-made annihilation
that made all previous disease epidemics seem like child's play.
In response to these new realities,
the past four decades have seen a
rekindling of the political and activist
consciousness within the health pro-

fessions, marked by the emergence of
international organizations such as
Physicians for Social Responsibility
( P S R ) , International Physicians for the
Prevention of Nuclear War ( i P P N w ) ,
and Physicians for Human Rights
( P H R ) . Faculty and graduates of the
School have been central figures in
the creation and evolution of each of
these organizations. Together with
Mann's Fran$ois-Xavier Bagnoud
Center for Health and Human
Rights, which provides a kind of academic counterpart to the advocacy
agencies, these organizations embody
Virchow's century-old dictum that
politics isâ&#x20AC;&#x201D;or should beâ&#x20AC;&#x201D;medicine
writ large.
S THE COLD WAR BETWEEN

the United States and the
Soviet Union intensified and nuclear
weapons stockpiles grew, the prospect
of a nuclear war seemed imminent.
By i 9 6 0 the two superpowers had
amassed enough nuclear weapons to
destroy nearly all life on the planet.
Yet, in America, at least, the national
mood was one of "can-do" optimismFamilies built bomb shelters in
their basements and backyards, while
politicians and military experts openly discussed strategies and contingencies for winning a nuclear war.
At the School, however, a group
of students led by George Saxton,
M.p.H.'6i, had been meeting and conducting its own study group and
had come to a different conclusion.
A Quaker and long-time grassroots
activist, Saxton recalls being asked
during student orientation what
he thought was the most important
public health issue facing the world's
people.

The first major cholera
epidemic in the
Americas in a century
strikes Lima, Peru,
causing 100,000 cases
and killing 700.

"Holy smoke, it's nuclear w a r , "
he remembers thinking. "We have to
do something about this." In an article published in the January 1 9 6 1
Alumni Bulletin, Saxton argued that,
given the untold death and destruction that would result from a fullscale nuclear war, prevention was the
only rational response to the nuclear
threat. Around the same time,
Bernard Lown, a cardiologist in the
School's Department of Nutrition,
was invited by a colleague to a talk in
Cambridge. The speaker was the
British diplomat Philip John NoelBaker, winner of the 1 9 5 9 Nobel
Peace Prize for his role in founding

ed to the United States in 1 9 3 $ , says
what moved him most to take action
was the disturbing parallel he saw
between the proliferation of nuclear
weapons and Nazi Germany's
orchestrated annihilation of 6 million
European Jews: "We destroyed Hitler
and we became Hitlerized in our a
bility to design mass extermination."
Lown called together a group of
colleagues and friends to discuss how
they, as physicians and as health
professionals, could educate the public about the fallacy of the belief in
surviving a nuclear war. Calling itself
Physicians for Social Responsibility
( P S R ) , the group undertook an

Arfzc/e

On the basis of its study, PSR produced a series of articles that the
group hoped to publish in the New
E w g ^ w J /oM?*?Mf o^Me&'cz'we. Lown
says that when he approached the
journal's editor, Joseph Garland,
however, Garland scoffed at the idea.
"We're a medical journal...not a political journal," Lown recalls Garland
saying. But the persistent Lown eventually convinced Garland to look at
the articles to see if they met the journal's rigorous publication standards.
Lown says Garland called him at the
end of the day and agreed to publish
the studies, which appeared under the
title "The Medical Consequences of

2 J

EVERYONE HAS THE RIGHT TO A STANDARD OF LIVING
ADEQUATE FOR THE HEALTH AND WELL-BEING OF HIMSELF AND OF
HIS FAMILY, INCLUDING F O O D , CLOTHING, HOUSING AND
MEDICAL CARE AND NECESSARY SOCIAL SERVICES, AND THE RIGHT TO
SECURITY IN THE EVENT OF UNEMPLOYMENT, SICKNESS, DISABILITY,
W I D O W H O O D , OLD AGE OR OTHER LACK OF LIVELIHOOD IN
CIRCUMSTANCES BEYOND HIS CONTROL.
the League of Nations. Noel-Baker
spoke about the impending prospect
of a nuclear Armageddon. Lown was
transfixed.
"He was like an ancient Hebrew
prophet," he recalled. "Here I was
concerned with sudden individual
death and here's the potential for
mass sudden death." Lown, the son
of Lithuanian Jews who had emigrat-

exhaustive study of the medical and
public health impacts of nuclear war.
Among those present at the founding
of PSR was H. Jack Geiger, s.M.'6o,
a physician and veteran political
activist who would become one of the
organizations most active members.
Geiger would go on to co-found
the group Physicians for Human
Rights (see sidebar, page 74).

Yugoslavia breaks up, precipitating a brutal war
between the independent regions of Bosnia, Croatia,
and Serbia.

Thermo-nuclear War," in the May 3 1 ,
1 9 6 1 , issue of the journal. In an
impressive 29 pages, the articles
described what would occur if a single
nuclear bomb fell on Boston: Nearly
three million people in Boston alone
would die; over four million in
Massachusetts. Some $,000 physicians
would perish. Nuclear fallout would
poison the air and ground for decades.

Lown credits the articles in particular with "bursting the bubble" of
the idea that, if enough money was
invested, everyone could move underground in a massive network of shelters. "The shelter would be the most
dangerous place to be because the
firestorms would consume the oxygen and you'd be suffocated miserably and incinerated," he says.
Physicians, wrote Garland in his
introduction to the articles, should be
interested in this problem because
"no single group is as deeply
involved in and committed to the survival of mankind."
Over the next two decades, PSR
continued to work towards the elimination of nuclear weapons and other
instruments of mass destruction. It
saw some hope in 1968 when the
Nuclear Non-Proliferation Treaty
was signed by the United States and
1 3 7 other nations. But by the early
1980s, when Ronald Reagan won the
U.S. presidency on a strong arms
build-up agenda, discussions of the
strategic use of nuclear weapons and
"Star Wars" defense systems prompted Lown to take a new approach to

his campaign for nuclear disarmament. On travels to the Soviet Union,
he had met Yevgeni Chazov, then
director general of the Cardiovascular Institute and personal physician to
Leonid Brezhnev. In 1980, Lown
wrote to Chazov, asking if he would
be interested in launching an international collaboration of physicians to
prevent nuclear war. Chazov agreed,
and the following year the organization International Physicians for the
Prevention of Nuclear War ( i P P N w )
was born.
Like P S R , I P P N W sought to draw on
the special status of health professionals as impartial arbiters of political
and social trends, individuals whose
only objective was to protect and
preserve health. Unlike P S R , I P P N W
was, from the start, an international
partnership that set a high-profile
example of cooperation between two
ideologically opposed adversaries.
Four years later, in 1 9 8 5 , Lown
and Chazov traveled together to Oslo
to accept the Nobel Peace Prize on
behalf of I P P N W . To this day, he is
Harvard's only Nobel Laureate for
peace. In 1 9 9 3 , to mark Lown's
7PPNW
BerwarJ Loww
f/e/it) awJ Ywgem
C^azcw. Loww,
pro/essor ewer^MS

w

retirement from the leadership of
I P P N W , President Mikhail Gorbachev
sent him a note, dated September 6
and written on the back of the INF
treaty, the first substantial antinuclear agreement between the two
superpowers. Framed and hanging
on the wall in Lown's office, it reads,
in part, " I want to thank you for
your great contribution to preventing
nuclear war."
Another faculty member who
spoke out against the folly of nuclear
war was Dean Howard Hiatt. In
1 9 8 1 , Hiatt joined members of the
Pontifical Academy of Sciences to
make a personal plea to President
Reagan to consider the tremendous
medical consequences of a nuclear
war. Three years later, in an article in
J A M A , Hiatt argued further that,
given the incredible need for medical
care in this country, and especially in
the developing world, the cost of the
proliferating arms race was an irresponsible waste of resources. There
is a distinctly Vichow-ian echo in
Hiatt's call for reapportioning military expenditures toward social programs. In 1869, Virchow presented
a motion for disarmament to the
Prussian parliament, noting that
while funding for weapons was
increasing, moneys for education had
remained stagnant.

Departwewf

NarMrJ's 072/y
No^e/ LaMreafe w
peace.

Iraqi generals accept U.N. cease-fire terms, ending
the one-month long Persian Gulf War. in the war's
aftermath, HSPH researchers will travel to both Iraq
and Kuwait to study the effects of environmental and
infrastructural devastation caused by the war.

V E N AS F E A R O F " T H E B O M B "

gal'

E vanized one contingent of health
professionals to political action, the
rise of repressive dictatorships and
regional and civil conflicts in Southeast Asia, Africa, and South and
Central America sparked a different
form of medical activism. Reports of
widespread torture, slaughter, and

Soviet Union dissolves.

Activist's Activist: H. Jack Geiger, S.M/60
There are two things any activist
worth his or her salt must own:
unflinching principles and a police
record. Jack Geiger has both. The
principtes were acquired while
growing up on New York City's Upper
West Side. The record came courtesy
of police in Nevada, New York,
Chicago, and Setma, Alabama. Most
of the arrests were of the orderly,
round-them-up-then-send-themhome variety in which getting arrested w a s part of the strategy of the protest itself. But in Setma in
1965, Geiger found himself jailed in hostile territory on trumped-up
charges by officers willing to use intimidation or violence to derail
the accelerating civil rights movement.
Geiger w a s in Selma at the request of Martin Luther King, Jr.,
as part of a delegation from the Medical Committee for Human
Rights (MCHR), an organization Geiger had helped found the
previous year. During the voter registration drives of Freedom
Summer, MCHR provided a "medical presence" for the thousands of
volunteers working throughout Georgia, Alabama, and Mississippi.
Geiger w a s being held on charges of practicing medicine without
an Alabama license for assisting in the care of the Reverend James
Reeb, a Boston Unitarian minister who had been beaten by local
thugs. Reeb would die from his injuries. And while the charges
against Geiger were ultimately dropped, the experience itself is
indelibly inscribed in his characterâ&#x20AC;&#x201D;one of the many "badges of

displacement of civilians by armed
militia and paramilitary groups led to
a recrudescence of humanitarian relief
efforts. In
awJ PzvMc Heaff^,
Barry S. Levy, M.p.HL'70, and Victor
W. Sidel note that, since the end of
World War II, the percentage of civilian casualties during military conflicts
has increased from 1 0 to 90 percent
of all casualties.
Equally distressing to health-care
Professionals was the apparent disregard for medical neutrality in many

honor" that he's earned in a career of social and political activism
that spans 5 decades.
Geiger's entree to activism came as a student at the University
of Wisconsin in 1943, when he founded one of the first chapters of
the Congress of Racial Equality (CORE). He subsequently served as
civil liberties chairman of the American Veterans Committee leading
campaigns to end racial discrimination in medical school admissions
and in hospital careâ&#x20AC;&#x201D;an issue he still pursues with vigor. He would
go on to help found Physicians for Social Responsibility and
Physicians for Human Rights.
It w a s while working in the poor rural reaches of Mississippi and
Alabama that Geiger began hatching the concept of the community
health center for which he is now best known. The centers combine
clinical medical care and public health interventions into a single
program and use both to facilitate social change. The original centers
that Geiger helped establish in Mound Bayou, Mississippi, and
Columbia Point, Boston, became the models for a national network
of urban and rural health centers that now numbers more than
800 and serves more than 10 million low-income and minority
individuals across the nation.
Today Geiger, the Arthur Logan Professor of Community Medicine
Emeritus at the City University of New York Medical School, regards
the community health centers as his greatest contribution to public
health. "I think, in terms of the number of people who they've
benefited, the community health centers have been enormously
successful," he says. That they were inspired by Geiger's experiences
as a political organizer suggests a corollary to Virchow's axiom:
sometimes health is politics writ small.

areas of conflict, in clear violation
of the 1949 Geneva Conventions,
which mandate nondiscriminatory
access to medical care and protection
of hospitals and health-care workers
during wartime. In El Salvador,
health-care workers were beaten,
imprisoned, or killed for providing
vaccinations. In Chile, physicians
were arrested for providing medical
care to people whom the government
considered terrorists. And in many
war-torn areas, soldiers entered

hospital wards and shot patients
lying in beds.
Health professionals had been
involved in humanitarian relief
missions for over a century, largely
under the auspices of the Swiss-based
International Committee of the Red
Cross ( i C R C ) . Founded on bedrock
principles of political neutrality, i C R C
volunteers set up held hospitals to
care for civilian and military casualties on both sides and ensure that
combatants obeyed the rules of war

DEADLY

MtapmcEs!

Pead/y Consequences Mow Wo/ence /s Pesfroy/ng
How Violence
Our Teenage Popu/af/on, by faculty member Deborah
fs Destroying
OnrHenage ; Prothrow-Stith, calls for a public health approach to
fbpuiationand!
a Han to Begin ; halt violence, which has become the second leading
SoMngthe ;
cause of death for U.S. males a g e s 1 5 - 2 4 .
PtuMem !

FDA approves ddl as an
alternative to zidovudine
for treating AIDS.

police attacks on blacks protesting
apartheid. In 1 9 8 6 , Fine and Schaller
called together a number of their
professional colleagues, among them
the ubiquitous H. Jack Geiger, and
launched the organization Physicians
for Human Rights (PHR).

Pro/eMor
s.M.'yo

listed in the Geneva Convention. In
the wake of World War II, however,
organizations such as Medecins Sans
Frontieres arose that challenged the
Red Cross's unswerving commitment
to neutrality, especially in civil
conflicts in which unarmed civilian
populations were targeted by heavily
armed militias or government forces.
In 1 9 8 3 representatives from the
International League for Human
Rights and the AAAS Committee on
Scientific Freedom and Responsibility
went to Chile, Uruguay, El Salvador,
and South Africa to document the
effects of abuse on citizens. One of
the physicians to go was Jonathan
Fine. Upon his return to the United
States, Fine, a long-time member
of both IPPNW and P S R , met with
another Boston physician, Jane Green
Schaller, who had just returned from
South Africa, where she had witnessed similar evidence of brutal

PHR's mission is to "bear medical
witness" to human rights abuses
by documenting the physical and psychological evidence of those abuses.
PSR study teams perform autopsies and
conduct forensic studies on human
remains to determine whether torture,
abuse, or murder have occurred; they
interview and examine survivors about
alleged human rights abuses; and
they use the tools of epidemiology to
assess the civilian toll of war and
armed conflict. The scientific documentation of these abuses, conducted
by trained professionals, stands as
credible evidence in courtrooms and
inter-national tribunals; without such
documentation, the stories of beatings
and other abuses would only be tales.
PHR physicians are "giving pain a
face and death a name," said Jennifer
Leaning, s.M.'yo, instructor in health
and social behavior, speaking at PHR's
tenth anniversary symposium last year
in Boston. Leaning is one of many
H S P H faculty and alumni who have led
fact-finding missions under the auspices of PHR. In 1 9 8 8 , Leaning teamed
with fellow graduate H. Jack Geiger,
s.M.'6o, to report on the status of
medical care in Israel's West Bank
and Gaza Strip. T w o years later, at the
request of exiled scientist Andrei
Sakharov, Leaning traveled to Tbilisi
in Soviet Georgia under the auspices
of PHR to document the harm caused
when Soviet troops broke up a peaceful demonstration using entrenching

MHS

1992

VIII International AIDS Conference, cosponsored by
Harvard and scheduled to be held in Boston, is moved
to Amsterdam as conference organizers protest
federal restrictions on HIV-infected travelers. Despite
the c h a n g e in venues, the Conference d r a w s 10,000
participants.

WoM
r
inMH!

.liMMth"" Maim.

H

spades and gas believed to have been
toxic. Sixteen people were killed
that day, another four died later, and
hundreds were injured.
The list of faculty and graduates
who have been affiliated with PHR is
long and growing. Paul Wise,
M.p.H.'y8, assistant professor in the
School's Department of Maternal
and Child Health, was part of a team
that investigated the "human costs" of
Operation "Just Cause," the U.S.-led
invasion of Panama in 1 9 8 8 . Howard
Hu, s.D.'9o, M.p.H.'8o, associate
professor of occupational health, has
led fact-hnding missions to evaluate
the use and effects of tear gas. In
1 9 8 7 he went to Seoul, South Korea,
and in 1 9 9 1 to Myanmar, formerly
Burma. Paul Epstein, M.p.H.'83, lecturer in the Department of Population
and Internationa] Health, went to the
Turkey-Iraq border region in 1 9 9 1
to assess the medical condition of over
2 million Kurdish refugees following
the Persian Gulf War.
Leaning's extensive experience in
some of the world's hottest hotspots
has led her to try a n d identify societal

elements, especially breakdowns in
public health, that prime an area for
the type of civil unrest and armed
uprisings that have occurred during
the past decade in Somalia, Haiti,
and the former Yugoslavia. Leaning's
work as director of the Program on
Complex Humanitarian E m e r g e n c i e s
seeks to identify the key characteristics, such as massive population
dislocation, extensive e n v i r o n m e n t a l
destruction, and high levels of civilian
insecurity that render a community
vulnerable to disintegration. She
hopes that by identifying factors that
precipitate these crises, public h e a l t h

/t/DS /n f/;e Wor/d' /S G/oba/ Reporf, edited by
Jonathan Mann and Daniel Tarantola of the School s
Global AIDS Policy Coalition, is the first comprehensive analysis of the global AIDS epidemic. The book
estimates t h a t 13 million people worldwide carry the
AIDS virus and predicts that, by the year 2000, up M
110 million people will be infected.

professionals and politicians may
begin to be able to anticipate, prepare
for, and, ideally, prevent them from
occurring. The idea of preventing
armed conflict would seem a quaint,
post-sixties "save-the-world" notion
if it weren't for Leaning's clear-eyed
determination and the fact that her
beliefs echo the hopes of an earlier
HSPH graduate who witnessed firsthand the devastating consequences
of war. In a 1 9 4 4 essay in the Alumni
Bulletin, Brigadier General James
Stevens Simmons, S.D/39, who subsequently became dean of the School,
wrote: "One might be allowed to hope
that eventually, through the development of preventive medicine, it will be
possible to prevent the most pernicious
of all diseases, war itself."
^ A !

ANN'S FRAN^OIS-XAVIER

H w ) Bagnoud Center for Health and
Human Rights serves as an intellectual
bulwark for and collaborator with
PSR and other organizations engaged
m front-line humanitarian relief and
human rights activities. Mann says
that the foundation for the center's
mission is the $o-year-old Universal
Declaration of Human Rights. Perhaps
because only one of the declaration's
30 articles deals explicitly with the
tight to health, health professionals
did not immediately rally behind
the declaration, and the human rights
movement for much of the past five
decades was dominated by legal and
political activists.
But Mann, reading the document
four decades after it was published,
saw it differently: "What struck me
Was that reading it from a public
health perspective, the whole declaration is about health and the social

conditions people need to be
healthy." T o his mind, the right to
not be held in slavery or be tortured,
the right to privacy and equality
before the law, and the right to an
education and to practice one's religion—all directly impinged on health.
From this realization, Mann devised
a simple but profound equation: for
each human right denied to an
individual or community, there is
a negative impact on health. The
strategy that grows from that equation—address the underlying human
rights issues, and increased health
will follow—is the basis for what he
proposes as a new framework for
public health.
" [The authors of the U.N.
Declaration] basically said that if the
Universal Declaration is realized, then
the societal preconditions for human
well-being will be met. There will still
be Mozarts and there will be people
who can't carry a tune, but the basic
fundamental principles for human
well-being, that allow the individual
to flourish, will be set, and the
social conditions for health will be
advanced," he says. "This is exactly
where I position public health."
In an effort to spread his new
gospel of public health, Mann, upon
joining the School's faculty in 1 9 9 0 ,
introduced the practice of handing a
copy of the human rights declaration
along with the diploma to every
graduate. He also began designing
courses on health and human rights,
both at the School and at the faculty
of arts and sciences and Kennedy
School of Government.
Mann's pursuit of his new vision
got a lift in 1992., when a Swiss
countess, Albina du Boisrouvray, gave

the School a $2.0 million gift to fund
the Frangois-Xavier Bagnoud Center
for Health and Human Rights and
the Franqois-Xavier Bagnoud
Professorship in Health and Human
Rights. " T o me, [Jonathan Mann] was
a warrior fighting against AIDS at
large, standing for health and human
rights, committed to rescuing the
discriminated, the most destitute, the
most vulnerable ones," said du
Boisrouvray at the dedication of the
Frangois-Xavier Bagnoud Building
in October 1 9 9 6 .
Inscribed on the outside wall of
the new building, in the six official
languages of the World Health
Organization, is a phrase from the
WHo's Constitution: "The enjoyment
of the highest attainable standard of
health is one of the fundamental rights
of every human being."
Mann, who last year left the School
to become dean of the Allegheny
School of Public Health in
Philadelphia, believes that the health
and human rights movement whose
seeds he helped sow is finally beginning to flower. During his keynote
speech at the Second International
Conference for Health and Human
Rights, held at Harvard in October
1 9 9 6 , Mann described this new
covenant between public health and
human rights in terms that suggested
a rebirth: "The tectonic plates are
shifting, but it is at the intersection
of health and human rights that
the most radical transformation is
occurring, and it is there that the
future will lie. We are in the vanguard
of a movement. We have a deeper
belief that the world can be changed,
and in doing that, we give value to
the world.

HSPH nutritionists
assert that, contrary
to popular belief,
margarine is no more
healthy for the heart
than butter.

S A RULE, DEATH CERTIFICATES

^ ^ ^ are dreary documents, the
* ^ grim bureaucratic reminders
of human fraiity. For heaith workers,
the death certificate too often symbolizes a failure of the core functions of
protecting and extending life. Yet on
one occasionâ&#x20AC;&#x201D;May 8, 1980â&#x20AC;&#x201D;the
signing of a death certificate was a
cause for celebration and hope. On
that day, the delegates to the 33RD
General Assembly of the World

Health Organization (WHO) signed
their names to the first death certificate for a human disease: smallpox.
Few events in the history of public
health have had as much symbolic
meaning: for the first time, a lethal
disease had been permanently
uprooted from the planet through
a concerted prevention campaign.
Abdul Rahman Al-Awadi,
M . P . H . ' 6 $ , presided over the historic
assembly and called the occasion a

HSPH atumni and
facuity working with
the Wortd Heaith
Organization have
been major ptayers
in internationai
heaith.

Gioba!
Arena
Famine exacerbated by civil war kills more than
300,000 people in Somalia. Sudan, Angola, and
Mozambique face similar devastation.

The acquittal of white
police officers videotaped beating a black
man sparks two days of
rioting in Los Angeles.

FDA approves the
nicotine patch.

"persona! and professional thrill."
At the time the Minister of Heaith
for Kuwait, Al-Awadi had worked
with the WHO in a number of capacities since graduating from the
Schooi, including twice serving as
a member of the WHO Executive
Board. Al-Awadi's presence at the
ceremonial signing, coupled with
the fact that three H S P H alumni—
William Foege, M.p.H/65; Donald
Hopkins, M.P.H/70; and Ralph
Henderson, M.P.H.'yo—had played
prominent roles in the smallpox
campaign, meant that the event also
had deep significance for the School
of Public Health.
Hopkins had helped lead the
eradication campaign in Sierra
Leone, Africa, from 1967-68. In
his 1983 history of smallpox, P r i c e s
awJ
Hopkins traces some
of the key moments in a struggle
between man and disease that had
been waged off and on over 3 millenia. The 1 9 6 6 decision by the
World Health Assembly to launch
the global eradication campaign—
coming precisely 1 7 0 years after
Jenner's discovery of vaccination—
signaled that the endgame of this
struggle had begun in earnest. "One
of the most important challenges
facing the Smallpox Eradication
Program," writes Hopkins, was the
need to prove, as quickly as possible,
that the disease could be eradicated
from poorer countries in spite of
their inadequate health services.
Many thoughtful public health
specialists doubted that could be
done to the end of the campaign,
but the doubts were especially
prevalent during the SEP'S early
stages.

]

T WAS F O E G E , L E A D I N G T H E E R A D I -

< cation effort in West and Central
Africa, who achieved this "crucial
psychological victory," writes
Hopkins. Foege would go on to lead
the successful campaign in India,
before departing to join the CDC.
Henderson, who was part of the
West Africa effort, working in Lagos,
Nigeria, says, "the experience of
working on this program in West
Africa was a career highlight. It was
a crash introduction to West African
culture, public health, and the constraints of colonialism and socioeconomic development. Good tools
and good people at all levels made
it a spectacular success."
A decade later, Henderson was
selected to direct the WHO's stunningly successful Expanded Programme
on Immunization (EPt). He says that
his earlier experience with the SEP,
along with the support from many
national and international "alumni"
of the smallpox eradication campaign, were major factors in
making the EPi itself such a success.

was joined there by H S P H Dean
James Stevens Simmons, s.D.'39, who
subsequently reported in the School's
A/M7717?;'
that the School
was well-represented with alumni
serving as representatives from Japan,
Ceylon (now Sri Lanka), and China.
Conceived as part of the postWorld War II rebuilding effort with
the goal of strengthening national
health administrations, the WHO
has succeeded where several of its
predecessors failed. Nearly a century
before, the hrst International Sanitary
Conference (isc), held in France
in 1 8 5 1 , inaugurated an era of international action in public health.
Eventually the isc evolved into the
Ofhce International d'Hygiene
Publique (01HP), which survived
through the end of the First World
War, when the League of Nations
attempted to establish its own international health agency. World War
II, however, brought international
health collaboration to a virtual
standstill and destroyed or disrupted
national health services in many
countries. T h e f u n c t i o n s of the o i H P

^

INCE ITS C R E A T I O N IN J U N E 1 9 4 6

J as a special agency of the United
Nations, the WHO has been a hotbed
of exchange and collaborative activity
for faculty and alumni of the School
of Public Health. Among the United
States' delegates who signed the
WHO into existence was Martha May
Eliot, then chief of the United States
Children's Bureau and a member of
the School's Visiting Committee. Eliot,
who would later chair the School's
Department of Maternal and Child
Health, was also present the following
summer for the hrst World Health
Assembly in Geneva, Switzerland. She

Swiss Countess Albina du Boisrouvray gives $20
million gift to the School through the Association
Fransois-Xavier Bagnoud to create a professorship
and center to study health and human rights and to
name a new building to house the Center. This is the
largest philanthropic gift ever made to the School.

and the League of Nations agency,
along with those of the United
Nations Relief and Rehabilitation
Administration, a temporary
organization that assumed oiHP's
responsibilities during the war, were
ultimately transferred to the WHO.
Headquartered in Geneva, the
WHO receives funding from its 1 9 0
member states to confront diseases
ranging from malaria to mad cow
disease to Dengue Fever to AIDS on
every continent and in every corner
of the globe. The WHO's World
Health Assembly has quasi-legislative
powers, granted by the United

Resource-based relative value scale (RBRVS),
developed over the past four years by Professor
William Hsiao and colleague Peter Braun, alters
how doctors are reimbursed through Medicare,
paying more to primary care physicians and less
to specialists.

Nations, to decide which international heaith programs should be undertaken. The WHO Executive Boardâ&#x20AC;&#x201D;
made up of 3 2 members, designated
by as many states, but serving in
their personai capacitiesâ&#x20AC;&#x201D;is charged
with carrying out the directives of
the Assembly. The WHO Secretariat
is responsible for providing assistance
to individual nations and programs.
Much of the WHO's work is carried
out through decentralized regional
offices for Europe, the Americas,
Africa, the Eastern Mediterranean,
Southeast Asia, and the Western
Pacihc.
Over the past five decades, the
School's faculty and alumni have
been active in the WHO as administrators, program ofhcers, collaborators,
consultants, and advisers. Henderson,
for example, directed the WHo's
Expanded Programme on Immunization for 1 3 years before being named
assistant director general. When he
took over EPi, immunization coverage in developing countries was
negligible. By 1 9 9 0 , coverage had
increased to some 80 percent of children age one or under. Today, the
program prevents an estimated 3
million deaths annually from target
diseases. It has also made it possible
for the WHO to have the realistic
expectation that poliomyelitis will
follow smallpox on the path to
eradication by the year 2.000. Before
stepping down as assistant director
general, Henderson oversaw six
divisions or programs relating to vaccines and immunization, tuberculosis,
leprosy, tropical disease control,
research and training in tropica! disease, and the prevention of blindness
and deafness.

1993

As an alternative to the USDA's recently released diet
pyramid, the School's nutritionists, led by Department
Chair Walter C. Willett, develop the Optimal
Traditional Mediterranean Diet pyramid, advocating
less red meat, more breads and grains, and daily
exercise.

WHO'S

LMM5 ^Op^,

Gro Hgr/ew; BrMM^/aM^ a w J A&cfMj

R<!^?7M7!

are awowg ^ e

7?MMy H S P H aJMWM? w^o
af f^e WHO.

^eM ^ey

The breadth of interactions
between the School and the WHO,
formal and informal, make it impossible to give a comprehensive list
of W H O - H S P H activities over the
years. But a sampling shows that the
relationship between the two organizations has been both varied and
deeply influential to global health.
A poll of the School's graduates
taken in 1 9 5 6 revealed that 26 alumni had worked with the WHO in
some capacity. Lawrence Roberts,
M.p.H.'$5, a regional adviser in tuberculosis for the who Regional Ofhce
for the Western Pacihc, and James S.
McKenzie-Pollock, s.M.'^z, who
coordinated communicable-disease
services for the WHo's Regional
Ofhce of South East Asia, were typical of the large number of graduates
who gained hands-on international
health experience working out of
regional ofhces of the WHO. In the
1 9 5 7 A & w w BM/fe^w, Hans HelwegLarsen, M . p . H . ' $ i , reported that
he had recently been assigned to the
position of health statistician for
Indonesia after many years at the
WHO Tuberculosis Research Ofhce
in Copenhagen. In the same report,
John A. M . Karefa-Smart, M.P.H.'48,
informed his colleagues that he had
initiated a malaria and yaws control
program in Liberia before being
named public health officer for
Western Africa. Karefa-Smart c r e d i t ed courses he took in public health
practice and Dean Simmons' seminar
on international health for sparking
his interest in the work of the WHO.
In 1 9 5 0 , Vlado A. Getting,
D.p.H.'^o, was named a United States
representative to the third World
Health Assembly. At the time

Hantavirus outbreak in the American South-West
is traced to a rare virus carried by rodents.

the Commissioner of Health for
Massachusetts, Getting recalls
that on his flight to Geneva, he
was seated next to J . N . Togba,
M.p.H.'45), who had just graduated
and was serving as Liberia's representative to the three-week-long meeting.
Togba would go on to serve as
president of the seventh World
Health Assembly, the first of the
School's alumni to be so honored.
Eighteen years later, a Canadian
alumnus, Basil D.B. Layton, M . p . H .
'52., would also serve as president,
as would Al-Awadi in 1 9 8 0 .
Chang Y u o Shu, M.P.H.'47,
China's representative to the first
World Health Assembly, joined
the WHO Secretariat in 1 9 4 9 . Until
her retirement in 1 9 7 3 , Helen
Martikainen, S.D/65, oversaw the
WHo's health education services.
Martikainen noted that during her
2.$-year career at the WHO, her only
break from her work was the time
she studied at the School. Meropi
Violaki-Paraskeva, M.p.H.'50, served
the WHO in a variety of capacities
over a 3 5-year period, including serving as president of the 34th World
Health Assembly in 1 9 8 1 . She was
the fourth graduate of the School to
serve in this capacity.
Adetokunbo O. Lucas, s.M.HYG.
'64, believes that the greatest challenge of his three-decade-long career
in public health was the establishment of the WHO Special Program for
Research and Training in Tropical
Diseases, operated in collaboration
with the World Bank and the United
Nations Development Program.
Lucas directed the program from
1 9 7 6 to 1 9 8 6 , during which time he
raised some $ 3 0 million annually

and conducted training and research
in more than 1 0 0 countries. For his
1 0 years of work, Lucas can proudly
point to the more than 50 new products—including an effective multipledrug therapy for leprosy—developed
by the program to help combat
myriad tropical diseases.
] N THE MID 1 9 8 0 s , WITH TUBER-

] culosis riding the AIDS epidemic to
renewed prominence in industrialized
nations while continuing to hit developing nations hard, Arata Kochi,
M.S.'82, assumed leadership of the
WHO's TB program. Kochi was faced
with rebuilding a global program
that had essentially been neglected
for the previous two decades. In an
interview for the H ^ r M r J
H&3M7 ReMgw in 1 9 9 3 , Kochi said
his program's primary function is
"to build coalitions between governments, funding agencies, and other
major players" and to provide technical assistance to poor countries in
managing TB. Among those who have
helped Kochi to achieve these goals
have been several H S P H alumni,
including Peter Eriki, M.P.H.'84,
regional adviser for TB and leprosy in
Brazzaville; Sergio Spinaci, medical
officer for China and India; and WHO
scientist Diane Weil, M.S.'88.
For Jonathan Mann, M.P.H.'8o,
the WHO provided a platform for
mobilizing a global response to an
epidemic that would re-invigorate—
and ultimately redefine—public
health: A I D S . Mann, who launched
the WHo's G l o b a l P r o g r a m m e on AIDS

in 1 9 8 6 , was recruited to the WHO in
1 9 8 5 by Fakhry Assad, director of
the WHO's Division of Communicable
Diseases. When Mann arrived in

Newly elected President Bill Clinton appoints a
500-member task force to reform America's
health-care system. A poll by Professor Robert
Blendon, w h o advises t h e president, reveals that,
while public support for health care reform is at a
40-year high, few people are willing to sacrifice
their own care or pay more to finance changes.

Geneva, the program's only other
staff member was his secretary.
When Mann left, four years later to
join the faculty of the School of
Public Health, the program was the
WHo's largest, with a staff of over
300 and a budget of more than $ 1 0 0
million. Under Mann, the GPA established 1
national AIDS programs,
achieved true global mobilization
against the epidemic, and developed
a language and a conceptual framework based on preservation and
respect for human rights that Mann
believes is critical to help the world
address A I D S .
Mann points to the WHo's ability
to utilize the resources and expertise
of universities around the world as
one of the keys to its success. "With
the larger purpose of ensuring global
health, it is the WHo's responsibility
to take advantage of the resources
available," explained Mann.
The recent appointment of alumna
Gro Harlem Brundtland, M.p.H.'65,
as director general of the WHO represents a fitting culmination of the
productive W H O - H S P H relationship.
Brundtland, who assumes the post
in July 1 9 9 8 , has been one of the
world's most influential advocates
for international cooperation on
health and environmental issues. She
has thrice served as prime minister
of her native Norway. As chair of the
U.N.'s World Commission on the
Environment, she oversaw publication of the report " O u r Common
Future," which brought the notion
of "sustainable development" to the
fore of international health efforts.
She is the first HSPH graduate—and
first woman—to hold the post of
director general and those who know

A study by Associate Professor Katherine Swartz
reveals that, during the course of a year, up to 58
million Americans go without insurance for some
period of time.

her expect that she will bring an
energetic management and leadership
style to the organization that will
help it achieve new prominence in
international health.
In her presentation to the WHO
Executive Board prior to her
confirmation, Brundtland proposed a
more active role for the WHO as "a
catalyst for raising the status of
health on the international political
agenda. We cannot allow health to
remain a secondary dimension as we
focus our international resolve into a
new century. Health is pivotal.
Health is the core of human development."
COMPLEMENTING T H E L E A D E R S H I P

on the ground of the School's
alumni, H S P H faculty have played
important collaborative and consulting roles on WHO research and service
projects. Collaborative centers, too,
have been an important part of
the relationship between the WHO
and the School. In 1 9 8 1 , the WHOHarvard University Collaborating
Center for Cancer and Biostatistics
linked the School's biostatistical
expertise with the WHo's planning,
conduct, and evaluation of cancer
control programs. Center faculty
provide consultation and evaluation
for the activities of the WHO cancer
unit based in Lyon, site of the
International Agency for Research
on Cancer, which was established
under the WHo's auspices, in order to
hnd means of preventing cancer that
are effective and accessible to the
people of the developing as well as
the developed world.

In 1988, the WHO designed its first
international collaborating center for
health legislation. With A I D S as it's
first focus, the Center was placed at
the School, largely because of the
reputation of late faculty member
William J. Curran, s . M . H . ' $ 8 , founding director of the School's health
law program. The center conducted
the first international survey of A i D S related legislation and has tackled
such topics as international guidelines
for dealing with drug and alcohol
abuse. The WHO recently established a
similar collaborating center with the
Department of Nutrition, which seeks
to draw on the School's longstanding
strenths in nutritional epidemiology
and international nutrition.
Perhaps the most important
byproduct of H S P H - W H O collaboration is the recently completed G / o ^ /
study. Led by
Professor of International Health
Economics Christopher Murray
and WHO colleague Alan Lopez, this
landmark study is the first attempt
to develop a comprehensive set of
estimates for patterns of mortality
and disability for 1 0 7 chronic and
infectious diseases ranging from
A I D S to heart disease to depression.
Originally intended to correct many
of the discrepancies and inconsistencies in global reporting of disease
prevalence and incidence, the study
ultimately revealed some startling
insights about global disease trends,
including the fact that some non-fatal
illnesses, such as depression and diabetes, are a heavier health burden
to societies and the world than many
fatal illnesses.

To do the study, Murray, Lopez,
and more than 1 0 0 collaborators
around the world analyzed 1 4 million
death certificates and used that information to rectify the often glaring
gaps in disease incidence and mortality estimates. The first two of a
planned 1 0 volumes were released in
1996 and include morbidity and
mortality projections through the year
zozo. Murray's findings will be critical in planning for national healthcare needs in the coming decades.
As the W H O enters its 5 0 T H year of
protecting and preserving the health
of people around the globe, it has
more than 1 5 0 programs coordinated
in Geneva and countless others directed by the regional offices. The WHO
employs more than 5 , 0 0 0 scientists,
researchers, and administrators in the
Secretariat alone. From its headquarters in Geneva, it remains the health
consultant to the world. The exchange
of personnel, expertise, and resources
that has characterized the relationship
between the WHO and the School over
the last five decades of this century
will no doubt continue. Brundtland
has emphasized the importance to
WHO of partnerships with institutions
and agencies at every level dealing
with health. For his part, Mann
believes that one of the things the
School ought to be doing even more
of is fostering its relationship with
the WHO. "There is no meaningful
distinction between the national and
international arenas when it comes
to health," explained Mann. "It is
the School's responsibility to continue
its partnership with the WHO."

Kevin S o t t a k

Serbian nationalists lay siege to
Sarajevo and launch a wave of
violence that will culminate in
genocidal "ethnic cleansing"
campaigns against Muslims and

Human Development in Chicago Neighborhoods. T w o
million Americans are beaten, knifed, shot, or raped
every year. Of the 1 4 5 , 0 0 0 annual Americans deaths due
to injury, at least 56,000 are due to violence; 1 9 9 1 , the
year the CDC announced that murder was epidemic in
this country, saw 1 0 homicides for every 100,000 citizens. Scotland is a distant second with a homicide rate
that is only one-fourth of ours.
Not all violence leads to death, of course. Violence
destroys lives in a horribly versatile manner: For exam-

trated by and upon young people has shot up alarmingly. Injury and violence have replaced infectious diseese as
the chief killers of the young during the same period that
the young have become responsible for a wildly disproportionate amount of violence and crime. The homicide
rate among males 15-2.4 years old in the United States is
1 0 times higher than in Canada, 1 5 times higher than in
Australia, and 28 times higher than in France or in
Germany. One in hve violent crime arrests in 1994 were
of someone under 18 years of age.

WHO declares tuberculosis a "global emergency"
and estimates that the disease may claim as many
as 30 million lives over the next decade.

"We did have a skyrocketing of
adotescent and young adult homicide rates, an epidemic that the
biggest cities experienced hrst, in the
mid- to late 1 9 8 0 s , " says Earis.
"The second tier followed in the
early 1 9 9 0 s . For example,
Minneapolis saw its adolescent
homicide rate double between 1 9 8 7
and 1 9 9 3 . This is a real increase in
adolescent violence, and we have
learned to pay more attention to it."
Easily obtained guns are an
essential component of America's
violent profile, especially for children, say experts. Shooting is now
the chief cause of death for black
teens and is second only to motor
vehicle accidents in killing white
teen-agers. Firearms homicide for
youths 1 5 - 1 9 years old increased
1 5 5 percent between 1 9 8 7 and
1994.
As a result of the shifting demographics of violence, the focus of
research has shifted to the young. At
the same time, the nation has fairly
recently undergone a paradigm shift
that recast violence, formerly within
the purview of the criminal justice
system, as a public health problem.
In 1 9 7 9 , Surgeon General C. Everett
Koop hrst included violence prevention as one of the nation's top 1 5
health priorities. Under the direction
of Mark Rosenberg, the Centers
For Disease Control and Prevention
(CDC) promptly established its
Violence Epidemiology Branch. The
CDC organized symposia and conferences including the 1 9 8 5 Surgeon
General's Conference on Violence
as a Public Health Problem.
The story of how violence metamorphosed from a task for jailers

1994

ij^^yj^ / /
tIlP
SH ?
^ ^ ^ ^

and judges to a challenge for public
health and medical professionals
is closely intertwined with the efforts
of a small group of pioneers on
the faculty of the Harvard School
of Public Health. They include Earls,
whose meticulous, prospective studies ask, "Why do communities and
their individual members differ so
much in their crime rates?";
Professor Deborah Prothrow-Stith,
a charismatic writer who clothes the
insights of a clinician with the fervor
of a proselyte; Professor David
Hemenway, deputy director of the
School's Center for Injury
Prevention, who applies his expertise
in economics to original investigations of firearm injuries; and Jay
Winsten, director of the Center For
Health Communication, whose
"Squash-It" antiviolence campaign
employs the same sophisticated
social marketing strategies as his
highly successful designated driver
campaign that helped reduce
drunk driving in the 1 9 8 0 s .
Progress toward understanding a
problem as complex and elusive as
violence has been slow. " A t the end
of the zoTH century, we are as close
to understanding violence as we were
to understanding medicine in the
mid-i 8 0 0 s , " observes Earls. But the
extent to which we now define
violence as a public health problem
is illustrated by the fact that the very
criminal justice and law enforcement
proponents who once owned violence now call for partnerships with
public health practitioners. In 1 9 9 0 ,
Lee Brown, police commissioner of
New Y o r k , decried the city's record
1,905 homicides and called upon the
medical profession to study the psy-

On the heels of its successful "Designated Driver"
media campaign, the Center for Health
Communications launches the nationwide "Squash It!"
campaign to prevent adolescent violence. A survey
conducted by the Center has revealed that 15% of
America's sixth through twelfth graders have carried
a gun to school.

chological and physiological roots
and interventions, schools to educate
children to violence prevention and
churches to instill moral values that
can discourage violent behavior.
^

SINGLE BULLET CHANGED

THE trajectory of Felton
* ^
Earls' career, and, not
incidentally, the way we view social
science research, forever. Earls had
graduated from Howard University
School of Medicine in the late
sixties and in 1968 was a postdoctoral fellow in neurophysiology
at the University of Wisconsin at
Madison. In April, he withdrew
into a soundproof room for an
experiment requiring that he remain
isolated for several days. He emerged
from his research cocoon into a
transfigured world: The campus was
in chaos because Martin Luther
King, Jr., had been shot.
Elegant neurophysiological
abstractions were no longer an
option, recalls Earls. "King's philosophy of nonviolence crystallized
my interest in the issues surrounding
violence and crime. M y laboratory
had to be the community, and I had
to work with children because they
represent our best hope.
"I've always been interested in
urbanization and health, and I see
the planet becoming slowly urbanized in an irreversible way. It is a
one-way process, and we're not very
skilled yet in knowing how to build
a healthy city. Where cities have
the biggest social impact is on kids,
so that's the reason I'm in public
health. "
During the early 60s, crime rates
had risen dramatically. More police

were hired, more job training
materialized, and more interventions
and treatments were devised for
delinquents and the criminally violent. But, says Earls, "The few intervention programs that looked at
the outcomes beyond one year of
ending the program have found that
the effects wear off. In fact, the boys
who received help had somewhat
higher recidivism rates than the boys
in control groups."
By the late sixties, as crime continued to spiral out of control,
researchers undertook retrospective
studies, examining people who were

already exhibiting violent behavior in
an effort to identify predisposing
factors. These retrospective studies
fostered a post hoc ergo propter hoc
mentality that long informed how
policymakers looked at violence:
Poverty, drugs, alcohol, associating
with gun-toting friends, and even
smoking came to be viewed as directly causative agents of violence.
"The limitation of retrospective
studies is that you identify people
because they're already engaged in
the outcomes you are predicting,"
explains Earls. "It's like loaded
dice." Earls believes more subtle

"King's phiiosophy of nonvioience crystahized my
interest in the issues surrounding vioience and
crime. iV!y iaboratory had to be the community, and
t had to work with chiidren because they represent
our best hope."

Professor F e / t o n f a r / s

agents of destruction are probably at
work, factors that will help explain
why, even in the most destitute
neighborhoods, only a small fraction
of children and adults become violent. "As a scientist I have to say that
we are largely ignorant of how and
why people become violent. There's
been a lot of work on antisocial
behavior and violence, but nearly all
criminal research to date has studied
adults and older teenagers. By these
ages, intervention may be too late."
In March 1994, Earls launched a
massive study that applies the rigors
of prospective epidemiologic research
to the multifactorial problems of
violence and antisocial behavior. The
Project on Human Development in
Chicago Neighborhoods, sponsored
by the John D. and Catherine T.
MacArthur Foundation, the National
Institute of Justice, the National
Institute of Mental Health and the
Department of Education, will track
6000 children in 80 Chicago neighborhoods until 2.003 in an attempt to
identify factors that risk violent
behaviors. The study encompasses
African-American, Latino, white and
mixed ethnic neighborhoods and all
social classes. " B y a detailed study
of Chicago, we sample the whole
universe of urban America," he says.
" N o other study has attempted
to capture in a single design as much
of the class and ethnic diversity of
urban American. We're looking not
just at how individuals shape their
environments, but at how changing
social and physical environments
shape them."
By studying human development
in changing urban environments over
time, Earls hopes to tease out the

"Haiti: Crisis in Humanitarian Action," a study by the
Harvard Center for Population and Development
Studies, details widespread health consequences of
Haiti's military coup and the subsequent economic
sanctions imposed by the international community.

Violence Prevention: Fire With Fire

Television, movies, rap music—even the nightly news—have been
blamed for fueling violent impulses among young Americans. Jay
Winsten, an associate dean and director of the School's Center for
Health Communication, is using some of these same media outlets
to send a new message to the nation's youth: keeping control is
macho.
Winsten and his colleagues are the creative
^
force behind "Squash It!" a nationwide, multimedia campaign that encourages young
Americans to walk away from violent confronta-wag
tions. The phrase, "squash it," was drawn from
^ !
focus group research with teenagers from
. i
Boston and other urban centers conducted by
^
Winsten and center colleagues Susan Moses and &
Terri Mendoza in 1994. Later, Moses and
Winsten developed a hand signal—a
modification of the time out "T" from sports—
to accompany the phrase.
Explaining the project, Winsten commented,
"Our strategy relies on a critical observation that
emerged from our focus groups and was
confirmed in our national survey research:
although the dominant social norm is that you must stand and
fight, a majority of teenagers in our survey (including a majority of
urban youth who have been involved in serious violence) secretly
believe that it shows strength, not weakness, to walk away. This
finding offers a window of opportunity to make public and validate
the privately held belief of a majority of teenagers, use this as a
wedge to change social norms, and thereby grant social sanction to
what most teenagers already w a n t to do—walk away."
Unveiled in 1995, "Squash It!" employs traditional social marketing strategies—public service announcements (PSAs), highprofile celebrity endorsements, and posters—along with tech-

causes of antisocial behaviors such
as violence and substance abuse and
also to devise interventions and
inform policy. Seven age cohorts of
from 500 to 1 0 0 0 children are being,
followed over an eight-year period;
by overlapping the cohorts, the study
_

Poputation Poficies
Reconsidered

niques that Winsten refined during SPH's Designated Driver campaign, which helped to sharply reduce drunken driving fatalities in
the late 1980s and early 1990s. For that effort, Winsten convinced
television writers to integrate the designated driver concept into
the plot lines of 160 popular prime time shows. This same technique is now being used to promote the central
\
message of "Squash It! " — t h a t it's cool to
M A
walk away.
§
"Squash It!" PSAs have been broadcast dur^ ^
ing the Grammy Awards, the NCAA men's basketball tournament and on MTV and Black
Entertainment Television while subtler anti-violence themes have been incorporated into Fox
TV's "Beverly Hilts, 90210" and "New York
^^^
Undercover," ABC's "Dangerous Minds,"
NBC's "ER," and other prime time episodes.
Winsten may be the only Harvard associate
H
dean w h o has "juice" with rap stars: performers Coolio, Method Man and KRS One have
^
^ L
employed the "Squash It!" slogan and hand
signal.
"This notion—that you can walk away
without losing face—is a very important part of what w e need to
communicate to our children," says colleague Deborah ProthrowStith, professor of public health practice and head of the School's
Violence Prevention Initiative.
For all its visibility, Winsten stresses that "Squash It!" is meant
to complement, not replace, other anti-violence efforts. "It's not a
panacea," he says. "Violence prevention will take many effective
approaches. The totality will make a major difference."An evaluation of the impact of "Squash It!" currently is being conducted by a
SPH research team that includes Drs. Steve Buka, Steve Gortmaker,
and Penelope Greene.

approximates 2.5 years of research.
The study is unique not just for
the number of people enrolled and
the period of time of looked at,
but for the range of individual, family, and community variables being
studied.

"We start in childhood, much
earlier than legal interventions, and
we look at communities as well as
family and individual effects," says
Earls. "We plan to identify neighborhood influences that affect children
for good or ill as they mature....

— — — — — —
Popu/af/on P0//0M /?ecofK/oered, coedited by Lincoln
Chen, Gita Sen, and Adrienne Germain, refocuses
population control efforts on the health of w o m e n
and provides the intellectual foundation for the U.N.
Conference on Population and Development in Cairo.

Investigators in the School's Center for the Prevention
of Cardiovascular Disease identify the molecular
mechanism by which homocysteine, an amino acid
found in the blood, promotes atherosclerosis.

in adolescenceâ&#x20AC;&#x201D;by setting curfews
and having clubs and athletic facilities, so that adolescents have some
positive activities. When a community
deteriorates, the loss of supervision
and opportunities for constructive
activities may result in high levels
of violence."
H N LATE J A N U A R Y 1 9 7 8 , A D E C A D E

"Earty on, we saw that bad environments and
substance abuse contributed heavity to the viotent
behavior we saw."
Many studies don't distinguish
between witnessing violence and
experiencing violence. They don't
include sexual violence. I wanted
to get a broad view of violence that
could occur in family, home, and
school. I think this is important
because many studies specialized in
one or the other and have not been
in a position to answer questions
about how they look when you combine factors. "
The data gathering is proceeding
rapidly, and although it's too early
to analyze data, says Earls, "One
interesting finding so far is that there
are no poor white communities in
Chicago. There are many poor white
kids, but they're not concentrated in

Deborah Profhrotv-St/th

communities. They are distributed
across working-class and mixed-ethnic neighborhoods. That alone tells
you that the average poor white kid
is growing up in better circumstances
than the average poor black kid.
The most common neighborhood in
Chicago is a poor black neighborhood. This is a stark reality."
But Earls is cautious about leaping to the conclusion that poverty
per se is the root of all violence.
"The fact that violent criminals and
victims of crime are disproportionately members of minority groups is
not strictly related to poverty," says
Earls. "It also has to do with the
extent to which families and adults
in a community monitor children

"Binge drinking" among college students makes
headlines as a study by Henry Wechsler of the
Harvard Alcohol Project reveals that nearly half
of all undergraduates drink four to five alcoholic
beverages in a row.

! after Earls emerged from his
! sound-proof laboratory, a thirdyear medical student at Harvard was
coming to terms with the strangely
passive mentality toward violence
adopted by her colleagues. On a stint
in the emergency room during her
six-week surgical rotation at
Brigham and Women's Hospital,
Deborah Prothrow-Stith saw, along
with the sore throats, broken bones,
and heart attacks, teens who were
losing gouts of blood from knife and
gun wounds. At 3 a.m. one night, a
young man came in with a deep slash
across his brow. "If he'd been cut
an inch lower, he would have lost an
eye," recalls Prothrow-Stith. In the
fast-paced milieu of the E R , she concentrated on her training, explaining
as she sewed him up that she was
suturing patients on her own for the
first time. " H e told me he'd been
drinking heavily at a party, and he
flared into anger at a comment from
a guy he barely knew," she recalls.
Insults flew, and an argument erupted, punctuated in blood when the
other boy drew his knife.
"After I stitched him up, he
told me, 'Don't go to sleep, because
the guy who did this to me will be
in here in an hour, and you'll get all
the practice stitching you need.' He
delivered this with humorous brava-

Harvard AIDS Institute scientists led by Max Essex
and Phyllis Kanki discover that infection with HIV-2
may protect against infection with the more lethal
HIV-1.

8?

^
y

do, and both I and the senior resident laughed. But later, it dawned on
me that had he been joking about a
suicide attempt, we wouldn't have
laughed. In fact we would not have
let him leave."
Medicine appropriates everything:
Why did doctors shy from treating
violence as a medical problem, she
wondered? "It's not because it's a
complicated behavior: smoking, lead
poisoning, tuberculosis are all complicated by social aspects and poverty," she says.
Prothrow-Stith says she felt from
the hrst that the same public health
strategies that had been so successful
in curbing smoking and drunk driving could be employed to prevent
violence. For her senior project, she
wrote a curriculum for education in
violence prevention under the supervision of Sandy Lamb, who went
on to become Boston's deputy health
commissioner. After she graduated
in 1 9 7 9 , she got support from several quarters, including Boston City
Hospital Chief of General Internal
Medicine John Noble and Mark
Rosenberg at the CDC injury center.
Prothrow-Stith's senior project was
the precursor to her CMrncM/M??? To
Pre^gMf AJo/esceM?
that
is now used in hundreds of schools
internationally. David Nee at the
Florence V. Burden Foundation
funded writing of the curriculum.
After Prothrow-Stith finished her
medical residency at Boston City
Hospital, she started a program for
high-risk youth that became the
Boston Violence Prevention
Program. "When we hrst started,
people thought we were a little odd
because we treated violence in a

health-care context. But early on, we
saw that bad environments and substance abuse contributed heavily to
the violent behavior we saw." Her
anti-violence efforts attained higher
visibility when, at 3 3 , she became
the youngest personâ&#x20AC;&#x201D;and the hrst
womanâ&#x20AC;&#x201D;to serve as Commissioner
of Public Health for Massachusetts.
In 1990, she left the post to join the
School's faculty, where, as Professor
of Public Health Practice, she has
continued her crusade to bring violence prevention within the rubric
of public health. Her 1 9 9 1 book
D e ^ J f y CofMg^MgMces combines
anecdote and analysis to support the
public health approach to violence.
Prothrow-Stith feels that the
efficient way to reduce homicide and
assault is to focus on defusing the
explosive scenario of two armed
acquaintances seized by a sudden
anger that is fueled by alcohol or
drugs. The youth of those involved
in killings, the fact that both the
"aggressor" and the "victim"
tend to be poor, of the same race,
exposed to violence in the past,
depressed, and know each other
argues for treating both as victims,
she says. "Each is likely to feel
that hghting is his only choice,"
says Prothrow-Stith. Parents often
abet this reaction by socializing
children to feel that it is somehow
shameful to walk away from a hght.
"Children are not to be blamed
for their inability to handle anger in
non-lethal w a y s " , she says. "We
as parents, as teachers, as clergy, as
health care providers have failed to
teach them this basic skill...I think
the outcome of violence is determined by environmental, cultural

First International Conference on Health and Human
Rights, sponsored by the Fran^is-Xavier Bagnoud
Center for Health and Human Rights, is held in
Cambridge and draws hundreds of human rights and
health professionals from around the world.

and social factors: Kids learn to use
violence."
She points to the shocking hgures
on gun-toting students as evidence
of kids' vulnerability. "Rarely have I
heard of an adolescent who is carrying a gun for reasons other than
protection. Inside, kids carrying guns
do not feel strong: they feel weak
and vulnerable. The gun they carry
is their compensation."
H o w does she answer those who
suggest that violent urges he in the
genes and thus are not amenable to
social programs or medical intervention? "The problem with such
research is that there are such wide
discrepancies in the homicide rate
from country to country. That makes
it hard to ascribe a biologically
determined genetic function. If there
were a small increase, you might be
able to attribute it to some predisposition. But when the U.S. rate is 70
times higher to 1 1 0 times higher, at
some point we have to say 'Stop
looking for genetic focus and concentrate on social and cultural factors.' We haven't had a homicide in
a child under 1 6 in Boston for 1 8
months, and while Boston is an
interesting city, we certainly didn't
change the gene pool."
Hk

H O W H E R E IS T H E P E C U L I A R L Y

] \ ]

American ambivalence
toward violence more evident
than in the issue of guns. Estimates
place the number of guns now circulating in the United States at over
2.00 millionâ&#x20AC;&#x201D;nearly one for every
man, woman, and child. With so
many firearms so readily available,
it's not surprising that gunshots are
the leading cause of death for black

Professor Jonathan
Mann leads a threemonth study of health
conditions in Bosnia and
declares the crisis a
"war on public health."

"We're now tooking at a contagion mode in
which peopie feei iess safe as their neighbors or
ciassmates acquire guns. This causes them to
acquire guns in response." Dav/d Hemenway
teens—and the second leading cause
of death for white teens.
"Day after day, 1 0 0 people die
from guns— and half of these are
suicides. Clearly it's an American
problem. Almost no other countries
allow handguns for personal enjoyment," observes David Hemenway,
deputy director of the Injury
Prevention Center and professor in
the Department of Health Policy and
Management. Hemenway, an economist, points out that there has
been relatively little research on guns
given their pubhc health importance.
Accordingly, he has become something of a one-man firearms think
tank, investigating who owns and
carries guns and why; how to
improve storage practices; the costs
and benehts of gun ownership; the
use of guns in self-defense; gun use
among adolescents, on college
campuses, and in suicide; and who
belongs to the National Rifle
Organization.
Hemenway has found, for example, that men are more likely to
own guns than women, Republicans
are more likely to be armed than
Democrats, and whites are more likely to pack hrepower than blacks.
Despite conventional wisdom, gun
owners who have had hrearms training are more likely than others to
be among the i in 5 who store guns

loaded and unlocked "We've
assumed that suicide, homicide and
accidental gun injuries were reduced
by training," notes Hemenway,
"but training seems associated with
poor storage habits."
Most recently, Hemenway and
Professor Robert Blendon analyzed
two decades worth of public opinion
polls that suggest the American ardor
for hrearms may have cooled: Gun
ownership declined from 48 percent
of households in 1 9 7 3 to 4 1 percent
in 1994. But, says Hemenway, this
promising trend is tempered by the
finding that even while shotgun and
rifle ownership dropped, handgun
ownership rose from 1 3 million to 2.4
million households during that same
period. Not surprisingly, this increase
in handgun ownership has been concomitant with a marked increase in
violent crimes. There were 4 1 7 crimes
for every 100,000 people in 1 9 7 4 ,
but this rate leapt to 746 in 1 9 9 3 .
Much of the gun control debate
still takes place in the law-enforcement arena, but in 1986 public health
physicians declared gun ownership a
"public health emergency," and J A M A
issued recommendations for stricter
gun control measures, citing not only
the 38,000 Americans killed by
hrearms but the 90,000 gun injuries
treated annually in hospital emergency departments.

The rise in handgun ownership
may be disquieting, but what does
augur well is the discovery that 90
percent of Americans— including
gun owners— believe that guns
should be withheld from youths
under 18 and from those with criminal records. 86 percent of Americans
support the Brady Act that includes
a 5 day "cooling-off" period and
provision for background checks on
those who wish to purchase guns.
The pubhc also supports the limit of
one handgun purchase per month
and a ban on assault weapons.
Hemenway's research supports
Prothrow-Stith's claim that children
carry guns for defense. He has found
that knowing victims of violence,
being threatened with a gun, having
friends and family who have guns or
are involved in drugs are all associated with a child's gun carrying. Yet
87 percent of children surveyed say
they want to live in a world with

English Channel tunnel
opens.

fewer guns and 76 percent, including
more than half of adolescent gun
carriers, want it to be impossible to
obtain guns. "Currently, it's easy,"
adds Hemenway.
"We're now looking at a contagion mode in which people feel less
safe as their neighbors or classmates
acquire guns. This causes them to
acquire guns in response," he says.
Everyone falls into a categoryâ&#x20AC;&#x201D;
susceptible, infected, or resistant.
Just as with TB, isolating and treating
a few "carriers" may have profound
health advantages; Hemenway's
studies suggest that training in
conflict resolution and open family
discussions may protect children
from catching the handgun "bug".
"This is such a contentious area.
It is hard to research, because the
NRA is attacking the CDC for giving
money to gun research. Gun-control
critics claim guns are more often used
in self defense than in crime, but our
surveys show this is not even close
to the truth." Other studies find it 43
times more likely that a gun in the
home will kill someone who lives
there than an intruder, and that guns
in the home also increase the likelihood of suicide. "The NRA says public health people are opposed to
all gun ownership," says Hemenway.
"I'm not. I advocate more rational
gun policies."

^ ^ ^

NE OF THE IMPORTANT

H strengths of Harvard's vio^ ^
lence-prevention strategies
is the cooperative nature of faculty
efforts. Their diverse approaches
often converge synergistically. For
example, Prothrow- Stith and Earls
have taught a course, "Violence in
America," for several years. " I am
the scientific presenter about causation," says Earls, "and Deborah
brings an interventional and therapeutic approach. We constantly
have crosstalk about what we know
from social and behavioral sciences
and how that relates to prevention."
David Hemenway is now collaborating with Earls' study, helping his
groups to better assess injuries that
stem from violence.
Jay Winsten, director of the
Center For Health Communication,
also lectures to the violence class.
And he literally got a hand from
Earls in designing his nation-wide
violence prevention
media campaign, (see sidebar) " I
was discussing with Jay work on
nonhuman primates showing
conflict avoidance," recalls Earls.
"Gesture is extremely important
in getting a creature to back off.
This got Jay and me to talking
about incorporating the .S^M^-?;.'
hand signal with his verbal
message."

Despite the large gaps that still
exist in understanding how and
why violence occurs, the School's
experts express optimism that a
multifaceted approach from publichealth practitioners, schools, parents' groups, the churches and law
enforcement will continue to reverse
the deadly trends. Prothrow-Stith
predicts that parents' groups such as
the National Coalition of Survivors
for Violence Prevention will have
the impact of Mothers Again Drunk
Driving. " I find the activism of
survivors of violence very exciting,"
she says.
As of March 1 9 9 7 , Boston had
seen no homicide involving a minor
child for eighteen months. " I don't
think this is an artifact," declares
Earls. "It's a real effect that demonstrates something. What happened
here is that many parts of the
communityâ&#x20AC;&#x201D;police, schools, afterschool programsâ&#x20AC;&#x201D;all combined.
But it's easy to back off. If that happens, I expect violence rates to rise
again.

U.S. Postal Service
unveils a stamp
honoring public health
pioneer and former
faculty member Alice
Hamilton.

E L E V I S I O N V I E W E R S T U N E D INTO

] the A B C News program
K H "zo/zo" one Friday night last
June were offered a glimpse of what
co-anchor Barbara Walters called a
"revolutionary" new treatment for
heart disease. The segment was
narrated by the network's Medical
Editor, Timothy Johnson M . P . H . ' y 6 ,
whose characteristic professional yet
compassionate persona has earned
the respect and trust of two generations of television-watchers. For the
next 1 3 minutes, Johnson guided the
program's roughly 1 9 million viewers
through a complicated story about a
renegade Brazilian cardiac surgeon's
new technique to treat an enlarged
heart by cutting a chunk of heart
muscle away from the lower left ventricle. The fast-paced segment intercut shots of Dr. Randas Batista, the
Brazilian cardiologist, in his "jungle"
operating room with footage of
Batista being interviewed by Johnson,
Batista riding a horse on his 300-acre
brush ranch, and animated graphics
illustrating the procedure.
Much has changed, both in television and in medicine, since Johnson's
first 30-minute broadcast aired nearly
2.0 years ago, when he hosted a local
program called "Housecalls." In that
time, Johnson—"Dr. Tim," as he is
known to his colleagues and public—
has led the way in the competitive
world of broadcast medical journalism. Practically every day, he shifts
between reporting on new medical
hndings or controversies and providing basic information about the
importance of screening for colon
cancer and hearing tests for children.
"Some say that I'm providing
cheap entertainment for hypochon-

National Center for Health
Statistics predicts that by
the year 2000, cancer will
overtake heart disease as
the nation's #1 killer.

driacs, but I like to think it's more
than that," says Johnson.
"He has the best public health
education job in the country," says
colleague Terry Schraeder, who
interned with Johnson before becoming a medical reporter at w c v B News
(Channel 5) in Boston. Former U.S.
Surgeon General C. Everett Koop, a
friend and colleague of Johnson,
agrees. "When you educate patients
the way Timothy Johnson is doing,
you empower them to take a larger
role in their health care," he says. "It
changes the paradigm of passive
patient and active physician."
A graduate of Albany Medical
College, Johnson was practicing
emergency medicine in Lynn,
Massachusetts, when he was recruited to host the local television venture
"Housecalls." The half-hour show's
low-key format consisted primarily of
Johnson and a guest discussing a single health topic, such as cataracts or
chest pain. The few graphics
employed were decidedly low tech. In
the early 1980s, Johnson hosted a
half-hour-long newsmagazine called
"Healthbeat"—a precursor to his
current Channel 5 News segment of
the same name—that included five or
six short segments. In 1984, Johnson
went national when he joined the
ABC News organization as medical
editor.

CAMERA

tagaw
Timothy
Johnson,
MPH '76

During this time, Johnson's on-air
patter has quickened a few beats to
keep time with the new demands of
the mediuim. But while the pace of
broadcasting has changed, Johnson
has earned respect for not abandoning his unique, physician cum journalist style, which integrates the perspectives of the patient wanting infor-

Ebola outbreak in Zaire

^
^
^
^

mation, the physician concerned that
his patient get the right information,
and the reporter asking the tough
questions to get it.
"He is enough of an expert that he
rises above the daiiy grind of news
stories and becomes an educator, an
on-air adviser to the pubiic on health
matters," says Phil Hilts, medical
writer for T/?e New Yor^ T;'we.s.
Johnson came to the School in
1 9 7 5 specifically to learn to evaluate
studies more rapidly and accurately
and to hone up on statistics. He credits Professor Marge Drolette with
providing an "excellent" instruction
in biostatistics. Drolette, who earned
her M.p.H. from the School in 1 9 5 4
and taught most of the required biostatistics courses, was known for her
unbridled enthusiasm towards both
her students and her subject. In a
memoriam that appeared in the
Alumni Bulletin in 1 9 8 7 , she was
called the "best-loved teacher in the
history of the Harvard School of
Public Health." (She also served as
chief coordinator for the M.P.H. program from 1 9 7 7 to 1 9 8 5 , and every
year at commencement, to show their
appreciation, graduating students
kissed her as she handed out diplomas. This tradition led former Dean
for Academic Affairs Elkan Blout to
call Drolette "the most kissed faculty
member" he had ever known.)
While at the School, Johnson also
collaborated with Steven Goldhnger,
dean for continuing education at

Alumnus Donald
Hopkins, M.P.H.'65,
named a MacArthur
Fellow for his efforts to
eliminate guinea worm
disease.

Harvard Medical School, to create
the Harvard Health Letter, a lay person's newsletter on medicine and
health.
"Tim was a man full of ideas that
were well thought-out and creative,"
says Goldhnger, who now heads the
Harvard Health Publications Group,
the umbrella organization that publishes the Harvard Health Letter as
well as five additional letters dedicated to specific health topics, such as
women's, digestive, mental, and cardiovascular health.
Johnson was also having a great
time, says William Ira Bennett, who
replaced Johnson as editor-in-chief in
1 9 7 9 . Headlines from the hrst few
issues of the Letter reflect Johnson's
sense of humor toward his subject:
"What You Should Know about
Heart Attacks Before You Die from
One," and "What You Always
Wanted to Know about Colds and
Flu, but Felt too Rotten to Ask." But
the Harvard Health Letter also
sought to provide useful information
to people, especially about preventive
measures such as tests ad screening,
and to do so in a way that was informative and respectful. "The basic
decision not to talk down to people
was something I really respected,"
says Bennett.
Today the health letter started by
Johnson and Goldhnger reaches some
2.50,000 people every month.
Through his new medium, however,
Johnson numbers his audience in the

tens of millions. During any given
week, Johnson appears several times
on ABC's news programs " 2 0 / 1 0 " ,
"Nightlme", "ABC N e w s " , " G o o d
Morning America", and "World
News Tonight". He also continues to
do spots called "HealthBeat" on the
local ABC news afhliate.
"He's always on the go," says
Judy Burke, who has been his assistant for 1 0 years and who produced
some of his earlier programs.
Johnson has won two Emmy Awards
from the Boston/New England
Chapter of the National Academy
of Television Arts and Sciences,
and the Lewis Thomas Award for
Communications from the American
College of Physicians. And in a 1995
T V Guide poll of the most trusted
television news personalities in
America, he ranked second, behind
Walter Cronkite.
"What is so good about what Tim
does," says Marcia Angell, executive
editor of the New England Journal
of Medicine, "is his ability to put
science into language the public can
understand." Angell describes
Johnson as an essential "link" in
the chain of health information.
" A link to people being healthier
and receiving better health care
is good accurate information," says
Johnson. "I like to see myself as
a public heaith teacher, albeit in a
different way than many."

Terri L. R u t t e r

Tropical disease specialist Sam Telford III identifies a
new disease, HGE, that resembles Lyme disease and
is carried by the same tick.

HE FIRST-EVER HSPH A L U M N I D A Y

H was scheduled to coincide with
commencement in 1 9 6 3 . Unfortunately, scheduling conflicts resulted in
the event being postponedâ&#x20AC;&#x201D;for 34
years. It wasn't until April 2.6, 1 9 9 7 ,
that the School would finally host
returning graduates as part of the
75th Anniversary Celebration. But
few of the more than 350 alumni
who attended the event complained
about the delay. Most were too busy
reminiscing, socializing, and enjoying
the day's activities, which included
roundtable discussions, a panel presentation, and a reception.

The event was organized by the
School's Alumni Association, now in
its 61st year of existence. Officially
formed by a vote of the class of
1 9 3 7 , the Association held its first
meeting in New York in October
of that year. Ninety-five of the
School's approximately 1,000 alumni
attended-an auspicious start to an
organization that has evolved over
time to meet the changing needs of
the School's graduates.

of the American Pubhc Health Assoc-

For the first several years, the
association limited itself to organizing and hosting an annual meeting in
conjunction with the annual meeting

Vlado A. Getting, D.p.H/40, who
served as the HM/fe^'s editor from
1944 until 1 9 4 9 , recalls that the early
days of the Alumni Association were

i a t i o n (APHA). A t t h e 1 9 4 4

however, members of the association
unveiled plans to publish the hrst
H^r^rJ^c/yooJo^PMMzcHeaM?
BM^efz'M. The magazine, written and edited by alumni, would
be the primary link to the School and
each other for a majority of graduates
for the next 45 years. (In 1 9 8 9 ,
the BM/Jefz'w was re-christened the
H a r f a r J PM^/z'c HeaM? ReMew.)

Six Decades of the
HSPH Alumni Association

U.N. holds Fourth World
Conference on Women
in Beijing.

93

meeting,

g^
^
^

o\
^
^

oriented toward socializing and
professional networking. "There
weren't that many schools of public
health at the time, and the Harvard
graduates were always out in fullforce for the APHA meetings. It was
fun to get together with one another
during the meeting and catch up."

involved in the day-to-day life of the
School. Dumbaugh had served first
on the Student Coordinating Council,
from which she was directly recruited
to serve on the Alumni Council, the
8- to 10-member committee that helps
determine the course of the association's activities throughout the year.

Thomas F. Whayne, Sr., D.P.H.'$o,
became president of the association
in 1 9 5 8 and, working with then-Dean
James Stevens Simmons, s.D/39,
began a more concerted outreach
effort to alumni. "Dean Simmons was
anxious to keep alumni connected
to the School," explained Whayne.
In addition to helping with the formation of regional alumni associations in the Philippines, Ceylon—now
Sri Lanka—and Japan, Simmons
also introduced fund-raising to the
association's agenda. By the 1960s,
alumni were being asked by
Association President Edmund G.
Zimmerer, D.P.H.'4i, to help underwrite the costs of the BM/fefv! and
provide students with much-needed
scholarship funds. Zimmerer also
pointed to the challenge of keeping
the School's large percentage of international alumni connected to the
School.

"When the association first started,
its focus was completely on communication among alumni, and it received
a lot of administrative support
from the School, like in maintaining
address lists," said Dumbaugh.
"But by the time I got involved, the
Alumni Association had become more
peripheral to the School. The Bulletin
wasn't supporting itself, Alumni
Day had not gotten off the ground,
and the mailing list was woefully
out of date."

T w o years later, under the leadership of Zimmerer's successor, Fred
Mayes, M.p.H.'^i, the association
voted to establish a standing committee on the Alumni Fund and Service
Program. The committee was
responsible for securing, on a continual basis, the resources for an
active alumni program that included
a revolving emergency student loan
fund. The association also began
exploring the possibility of increasing
its fundraising activities to support

1996

"Harvard Report on Cancer Prevention," prepared by
faculty in t h e Harvard Center for Cancer Prevention,
is a comprehensive, cause-by-cause u p d a t e on w h a t
is known about preventing cancer.

who served as president of the
association in 1968 and 1 9 6 9 , noted
that, "The Alumni Association for
the School, by its nature, was different than that of a college. Graduates
of the School may share a class
year, but are different ages and have
different professions. Yet we have
the bond of being alumni, and we
bump heads professionally. The
Alumni Association faced the continual challenge of finding ways to
keep in touch with graduates living
around the globe pursuing vastly
different interests."
By the time Karin A. Dumbaugh,
M.H.s.'72, s . D / 7 7 , became a member of the Alumni Council in 1 9 7 2 ,
students at the School—like those at
other institutions around the country
—were becoming more vocal and

Dedication of the
Fran^ois-Xavier Bagnoud
Building.

One of the first tasks Dumbaugh
and her colleagues tackled was the
creation of the School's first Alumni
Directory. "For many years, alumni
records were kept at the School by
staff who helped out with the association's activities, like Margaret Penrose
(the long-time director of Shattuck
International House) who had done
a wonderful job. But over the years,
addresses were lost or not updated,
and the alumni list was in bad shape,"
said Dumbaugh.
The Alumni Association also began
to focus more intensively on fundraising for student aid. One of its
early fund-raising efforts relied heavily
on support and assistance of the faculty. The association planned an auction
to add funds to a revolving loan fund
for students, particularly international
students who sometimes wound up
strapped for cash while awaiting
funding from their home country.

"Faculty really rallied around the
idea for the auction," reported
Dumbaugh, "and were instrumental
in its success." Dumbaugh recalls
that Dean Howard Hiatt auctioned
off a baking lesson, which included
dinner at his house as well. Alonzo
Yerby, M.p.H/48, chair of the
Department of Public Health Service
Administration, auctioned off a loaf
of bread, a jug of wine, and a copy
of the Rubaiyat, and Margaret
Penrose auctioned off her famous
cheesecake recipe. The auction raised
enough money to keep the revolving
loan program operational.

The U.S. FDA approves use of the fat-substitute
Olestra, despite opposition by Nutrition Department
Chair Walter Willett, who believes that the synthetic
fat robs the body of essential nutrients and may
increase rates of cancer.

ITU ^

ENDORSEMENT FROM

WW Dean Hiatt and the support of
a significantly larger and increasingly
enthusiastic alumni body, the association also completed a successful fundraising drive in 1 9 7 9 to establish a
scholarship in honor of Penrose. The
following year, the association organized a trip for 2.0 alumni to visit the
People's Republic of China. Alumni
came from across the United States
and from as far away as England,
Barbados, and Haiti for a tour that
also included stops in Egypt, Pakistan,
and Hong Kong. Proceeds from the
tour benefited the council.

President Clinton signs
the welfare reform bill,
which effectively cuts
funding to millions of
impoverished mothers
and children.

When Dumbaugh hnished her
term as president of the association
in 1 9 8 5 , the association was able to
award two scholarships annually.
Moreover, regional alumni associationsâ&#x20AC;&#x201D;which held meetings and were
involved in recruitment of students
as well as some fundraisingâ&#x20AC;&#x201D;were in
place in many parts of the United
States, Australia, Asia, and Europe.
Stephen C. Schoenbaum,
M.p.H.'74, got involved in fundraising activities at a phonathon, and
was then recruited directly to the
Alumni Council. Schoenbaum served
as president from 1993 to 1 9 9 $ .

"The Global Burden of Disease" is a landmark report
on the world's leading causes of death and disability
cosponsored by the HSPH, WHO, and the World
Bank. The 10-volume report, edited by Professor
Christopher Murray, left, and Alan Lopez, analyzes
the health impact of 107 major diseases and injuries
in 9 different global regions.

During his tenure, the association
began to explore an area of special
interest for him, student diversity.
"If you look at which schools of public health are most likely to attract
students from diverse racial and
ethnic backgrounds from within the
United States, you will see that they
are the public institutions with lower
costs," said Schoenbaum. To help
Harvard reach a more diverse population, the association raised enough
funds to establish the School's hrst
minority student scholarship in 1 9 9 5 .
NE OF THE MOST NOTEWORTHY

^ ^ recent efforts of the association
was the creation and annual awarding of the Alumni Award of Merit.
First bestowed in 1992., the Award of
Merit recognizes graduates whose
accomplishments in public health set
them apart, even from the many
distinguished leaders produced by
the School. As a council member,
Myron Allukian, Jr., M.P.H.'67,
helped spearhead the creation of the
award of merit. Allukian would go
on to serve as association president
from 1995 to 1 9 9 7 .
Responding to requests from
recent graduates for help in finding
jobs, the association has also worked
with the School's Career Services to
create the Alumni Career Advisory
Network. The network now includes
some 1,000 alumni, which represents

about a quarter of the alumni body.
Also under Allukian's leadership, the
election of class ofhcersâ&#x20AC;&#x201D;president,
vice-president, and secretaryâ&#x20AC;&#x201D;was
reinstated in 1995 for each graduating class.
The success of the first two
Alumni Day programs in 1 9 9 7 and
1998 confirms the fact that, while
you can take the alumni out of the
School, you never really take the
School out of the alumni. "It's obvious that the School's graduates want
to stay connected to the School.
The challenge for the association is to
continue to make it easier to do so,"
said Allukian.
"The primary role of the Alumni
Association has been, and always will
be, connection and communication,"
adds current President Joel Finlay,
M . P . H . ' 9 1 . " N e w a d v a n c e s in

communication, like e-mail and the
World Wide Web, are helping us
keep in touch with the School's
far-flung alumni. But it is really up
to the alumni to keep the momentum
going, to send information in for the
Class Notes section of the H a r t w J
PMM;c HeaM? ReM'ew, to return
to the School on alumni day, to visit
or become active in regional alumni
associations, and to attend the
School's alumni reception at the
a n n u a l APHA m e e t i n g . W e a r e

"Gateway to World Health: New Sciences and
Strategies in Public Health," a three-day symposium
staged in honor of the School's 75th Anniversary,
draws key faculty, alumni, and public health experts
from around the world.

Dean Harvey V. Fineberg announces that he will step
down at the end of the academic year to become
Provost of Harvard University. James H. Ware,
Frederick Mosteller Professor of Biostatistics and
Dean of Academic Affairs] is named Acting Dean
of the School.